Healthcare Provider Details

I. General information

NPI: 1366488942
Provider Name (Legal Business Name): SHIVALINI PATEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OLD COUNTRY RD STE 153LL
PLAINVIEW NY
11803-4942
US

IV. Provider business mailing address

875 OLD COUNTRY RD STE 153LL
PLAINVIEW NY
11803-4942
US

V. Phone/Fax

Practice location:
  • Phone: 516-935-1958
  • Fax: 516-827-0714
Mailing address:
  • Phone: 516-935-1958
  • Fax: 516-827-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number022313-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: