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General NPI Number Information
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NPI Number | 1396339990
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Entity Type | Individual
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Provider Name | SHIVANI PATEL
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Gender | Female
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 8008 ROUTE 130 STE 120
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City | DELRAN
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State | NJ
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Zip | 08075-1869
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Country | US
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Telephone | 844-542-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 400 LAUREL OAK RD STE 105
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City | VOORHEES
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State | NJ
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Zip | 08043-4455
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Country | US
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Telephone |
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP023181
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ01115000
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License Number State | NJ
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