Provider Demographics
NPI:1043387707
Name:PATEL, SHEFALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEFALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12624 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5448
Mailing Address - Country:US
Mailing Address - Phone:815-577-0900
Mailing Address - Fax:815-577-6446
Practice Address - Street 1:12624 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5448
Practice Address - Country:US
Practice Address - Phone:815-577-0900
Practice Address - Fax:815-577-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190258241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice