MEDICARE: WENDY SHIVAM PATEL

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1457977597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY SHIVAM PATEL

Provider Business Mailing Address
First Line	:	13223 DROXFORD ST
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-6201
Country	:	US
Telephone Number	:	562-315-3414
Fax Number	:

Provider Business Practice Location Address
First Line	:	797 S FAIR OAKS AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2629
Country	:	US
Telephone Number	:	562-315-3414
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/27/2025

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