Provider Demographics
NPI:1396214755
Name:PATEL, SHAIROZ SULTAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAIROZ
Middle Name:SULTAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2070 FIDDLEHEAD CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1601
Mailing Address - Country:US
Mailing Address - Phone:404-735-7115
Mailing Address - Fax:
Practice Address - Street 1:3970 DEPUTY BILL CANTRELL MEMORIAL ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-336-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant