Healthcare Provider Details

I. General information

NPI: 1750271359
Provider Name (Legal Business Name): SHEA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 OLD HIGHWAY 22
CLINTON NJ
08809-1389
US

IV. Provider business mailing address

19 RONALD DR
SOMERSET NJ
08873-5133
US

V. Phone/Fax

Practice location:
  • Phone: 908-730-6363
  • Fax:
Mailing address:
  • Phone: 609-516-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00945900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: