Provider Demographics
NPI:1437599867
Name:PATIL, SHAKUNTALA SACHIN (MD)
Entity Type:Individual
Prefix:
First Name:SHAKUNTALA
Middle Name:SACHIN
Last Name:PATIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3660 PARK SIERRA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:951-687-7630
Practice Address - Street 1:22555 ALESSANDRO BLVD STE B
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8533
Practice Address - Country:US
Practice Address - Phone:951-656-7081
Practice Address - Fax:951-656-1710
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA368453207RN0300X
IL125062971207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine