MEDICARE: SHAILY PATEL APRN

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	363LF0000X	Family Nurse Practitioner	30754	TN

General Provider Information

NPI Number	:	1639838428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAILY PATEL APRN

Provider Business Mailing Address
First Line	:	2927 WATAUGA RD UNIT 16
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-3890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2927 WATAUGA RD UNIT 16
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-3890
Country	:	US
Telephone Number	:	865-548-2630
Fax Number	:

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

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

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Directions to “ SHAILY PATEL APRN” Practice Location

Language	Start Address	Practice Location

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