Provider Demographics
NPI:1467918102
Name:PATEL, SHAMA (ND)
Entity Type:Individual
Prefix:DR
First Name:SHAMA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BUTLER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5943
Mailing Address - Country:US
Mailing Address - Phone:770-655-6398
Mailing Address - Fax:706-553-8394
Practice Address - Street 1:5755 N POINT PKWY STE 32
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1143
Practice Address - Country:US
Practice Address - Phone:678-871-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0130331175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherNON-INSURANCE PROVIDER