Provider Demographics
NPI:1477437424
Name:PATEL, SHIVANGI NAYAN
Entity type:Individual
Prefix:
First Name:SHIVANGI
Middle Name:NAYAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BRIGADOON DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2949
Mailing Address - Country:US
Mailing Address - Phone:860-865-9602
Mailing Address - Fax:
Practice Address - Street 1:1601 E BAY DR STE 1
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5616
Practice Address - Country:US
Practice Address - Phone:727-585-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30369125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist