Healthcare Provider Details

I. General information

NPI: 1235149600
Provider Name (Legal Business Name): SHEETAL PATEL GOLLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 MEMORIAL CT APT # 12104
HOUSTON TX
77007-6175
US

IV. Provider business mailing address

411 PARK GROVE LN SUITE 310 APT # 12104
KATY TX
77450-6175
US

V. Phone/Fax

Practice location:
  • Phone: 312-933-2392
  • Fax:
Mailing address:
  • Phone: 713-464-9100
  • Fax: 713-468-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberP2050
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: