Healthcare Provider Details

I. General information

NPI: 1508445073
Provider Name (Legal Business Name): SHRUTI PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N BEERS ST STE 1E
HOLMDEL NJ
07733-1523
US

IV. Provider business mailing address

655 SHREWSBURY AVE STE 308
SHREWSBURY NJ
07702-4151
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-4414
  • Fax:
Mailing address:
  • Phone: 848-379-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1508445073
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number328145
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB13081900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: