Healthcare Provider Details

I. General information

NPI: 1700379187
Provider Name (Legal Business Name): SHIVALI DIPAM PATEL JOHNSTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 DOE RUN RD
MANHEIM PA
17545-9314
US

IV. Provider business mailing address

80 DOE RUN RD
MANHEIM PA
17545-9314
US

V. Phone/Fax

Practice location:
  • Phone: 717-664-0952
  • Fax: 717-664-0955
Mailing address:
  • Phone: 717-664-0952
  • Fax: 717-664-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS020918
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT018524
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: