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General NPI Number Information
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NPI Number | 1992187082
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Entity Type | Individual
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Provider Name | SHRUTI A PATEL DPM
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Gender | Female
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 8320 OLD COURTHOUSE RD STE 401
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City | VIENNA
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State | VA
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Zip | 22182-3848
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Country | US
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Telephone | 571-619-8923
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Fax | 877-673-5259
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Provider Business Mailing Address
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Address Line | 8320 OLD COURTHOUSE RD STE 401
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City | VIENNA
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State | VA
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Zip | 22182-3848
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Country | US
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Telephone | 571-619-8923
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Fax | 877-673-5259
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00341900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103301290
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License Number State | VA
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Taxonomy #3
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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 | SC006651
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License Number State | PA
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