Healthcare Provider Details

I. General information

NPI: 1306360607
Provider Name (Legal Business Name): SHREYA PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11915 ATLANTIC AVE
RICHMOND HILL NY
11418-3216
US

IV. Provider business mailing address

106 WOODRIDGE DR
TULLAHOMA TN
37388-8876
US

V. Phone/Fax

Practice location:
  • Phone: 718-805-0700
  • Fax: 718-805-0700
Mailing address:
  • Phone: 816-457-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008571-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: