=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952197089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SHREEMA MAYURBHAI PATEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 W 14TH ST FL 3
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-0115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-930-2040
-----------------------------------------------------
Fax | 866-753-1668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 NELSON AVE APT 1
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07307-4597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-204-0839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 053484
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------