Healthcare Provider Details

I. General information

NPI: 1376070292
Provider Name (Legal Business Name): SHALINI PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W LANCASTER AVE STE 106
DEVON PA
19333-1588
US

IV. Provider business mailing address

8 WILDWOOD CT
EAST ISLIP NY
11730-3010
US

V. Phone/Fax

Practice location:
  • Phone: 610-646-7106
  • Fax:
Mailing address:
  • Phone: 631-521-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02825500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number061027
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS044019
License Number StatePA

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: