Healthcare Provider Details

I. General information

NPI: 1730766726
Provider Name (Legal Business Name): SHEFALI SHAILESH PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 CORONADO CENTER DR STE 141
HENDERSON NV
89052-3977
US

IV. Provider business mailing address

22 HASSAYAMPA TRL
HENDERSON NV
89052-6667
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-2400
  • Fax:
Mailing address:
  • Phone: 702-427-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25423
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: