Provider Demographics
NPI:1447081708
Name:PATEL, SHREYA RAJESH
Entity type:Individual
Prefix:
First Name:SHREYA
Middle Name:RAJESH
Last Name:PATEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 VAN WAGENEN AVE APT 707
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5214
Mailing Address - Country:US
Mailing Address - Phone:201-969-6394
Mailing Address - Fax:
Practice Address - Street 1:1350 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2790
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2025-04-03
Deactivation Date:2025-01-16
Deactivation Code:
Reactivation Date:2025-01-28
Provider Licenses
StateLicense IDTaxonomies
NY014357225200000X
NY053533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant