MEDICARE: SHREYA PATEL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV008571-1	NY

General Provider Information

NPI Number	:	1306360607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHREYA PATEL OD

Provider Business Mailing Address
First Line	:	106 WOODRIDGE DR
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-8876
Country	:	US
Telephone Number	:	816-457-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	11915 ATLANTIC AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-3216
Country	:	US
Telephone Number	:	718-805-0700
Fax Number	:	718-805-0700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	03/17/2018

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Directions to “ SHREYA PATEL OD” Practice Location

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