Healthcare Provider Details

I. General information

NPI: 1497611990
Provider Name (Legal Business Name): SHREJA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ROUTE 23 STE 180
WAYNE NJ
07470-7522
US

IV. Provider business mailing address

125 MINEOLA AVE STE 200
ROSLYN HEIGHTS NY
11577-2042
US

V. Phone/Fax

Practice location:
  • Phone: 516-616-5500
  • Fax:
Mailing address:
  • Phone: 516-616-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00977000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: