Healthcare Provider Details

I. General information

NPI: 1528123072
Provider Name (Legal Business Name): SHAILESH MANEKLAL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 TRICOM ST
NORTH CHARLESTON SC
29406-9171
US

IV. Provider business mailing address

2880 TRICOM ST
NORTH CHARLESTON SC
29406-9171
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5050
  • Fax: 843-797-3633
Mailing address:
  • Phone: 843-797-5050
  • Fax: 843-797-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29727
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number29727
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number29727
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number29727
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number29727
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: