Provider Demographics
NPI:1356443584
Name:PATEL, SHREENA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHREENA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PROFESSIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-7232
Mailing Address - Country:US
Mailing Address - Phone:904-241-2471
Mailing Address - Fax:904-241-5673
Practice Address - Street 1:150 PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-7232
Practice Address - Country:US
Practice Address - Phone:904-241-2471
Practice Address - Fax:904-241-5673
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 171871223G0001X
FLDN171871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP 9412571OtherDEA