=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477336477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHREE PATEL M.ED.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2023
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3975 UNIVERSITY DR STE 110
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-845-6940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25569 EMERSON OAKS DR
-----------------------------------------------------
City | ALDIE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20105-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-981-0774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0704015988
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------