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General NPI Number Information
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NPI Number | 1215593082
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Entity Type | Individual
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Provider Name | KHUSBUBEN SHANTILAL PATEL MD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 4124 CHESAPEAKE SQUARE BLVD STE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23321-2134
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Country | US
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Telephone | 757-983-5100
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Fax | 757-673-8292
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Provider Business Mailing Address
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Address Line | 4124 CHESAPEAKE SQUARE BLVD STE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23321
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Country | US
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Telephone | 757-983-5100
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Fax | 757-673-8292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101276311
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License Number State | VA
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