MEDICARE: DR. SHREENA B. PATEL D.M.D.

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	1223G0001X	General Practice Dentistry	DN 17187	FL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN17187	FL

General Provider Information

NPI Number	:	1356443584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHREENA B. PATEL D.M.D.

Provider Business Mailing Address
First Line	:	150 PROFESSIONAL DR STE 100
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-7232
Country	:	US
Telephone Number	:	904-241-2471
Fax Number	:	904-241-5673

Provider Business Practice Location Address
First Line	:	150 PROFESSIONAL DR STE 100
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-7232
Country	:	US
Telephone Number	:	904-241-2471
Fax Number	:	904-241-5673

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/07/2023

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