=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063305415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHETH & PATEL PODIATRY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 SANTA MONICA BLVD STE 465W
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-250-9383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 SANTA MONICA BLVD STE 465W
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-250-9383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND FOUNDER
-----------------------------------------------------
Name | DR. SUCHIR K. SHETH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-250-9383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------