Healthcare Provider Details

I. General information

NPI: 1619695582
Provider Name (Legal Business Name): SHWETA ALKESH PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6646 CARRIAGE HILLS DR
CANTON MI
48187-3042
US

IV. Provider business mailing address

6646 CARRIAGE HILLS DR
CANTON MI
48187-3042
US

V. Phone/Fax

Practice location:
  • Phone: 734-709-3959
  • Fax:
Mailing address:
  • Phone: 734-709-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704317773
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704317773
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: