Provider Demographics
NPI:1033806294
Name:PATEL, SHYAM JAYESH
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:JAYESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-5036
Mailing Address - Country:US
Mailing Address - Phone:706-542-1911
Mailing Address - Fax:
Practice Address - Street 1:250 W GREEN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-5036
Practice Address - Country:US
Practice Address - Phone:706-542-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHI-021468OtherPHARMACY INTERN LICENSE