Provider Demographics
NPI:1164831251
Name:PATEL, SHIVANI A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 E CAMELBACK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2718
Mailing Address - Country:US
Mailing Address - Phone:602-229-2200
Mailing Address - Fax:602-744-3928
Practice Address - Street 1:4200 E CAMELBACK RD STE 202
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2718
Practice Address - Country:US
Practice Address - Phone:602-229-2200
Practice Address - Fax:602-744-3928
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9945-33363L00000X
MARN2283371363LF0000X
AZ289311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner