Provider Demographics
NPI:1871878702
Name:PATEL, SHRADDHA MRUNAL (RN)
Entity type:Individual
Prefix:
First Name:SHRADDHA
Middle Name:MRUNAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 24 B
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3802
Mailing Address - Country:US
Mailing Address - Phone:845-510-1521
Mailing Address - Fax:
Practice Address - Street 1:160 NORTH MAIN STREET
Practice Address - Street 2:SUITE 24 B
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3802
Practice Address - Country:US
Practice Address - Phone:845-510-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647091-1163W00000X, 163WC1500X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator