Provider Demographics
NPI:1508201583
Name:STEWART, SHETAL PATEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHETAL
Middle Name:PATEL
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHETAL
Other - Middle Name:MAHESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:876 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:354 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5142
Practice Address - Country:US
Practice Address - Phone:720-230-2252
Practice Address - Fax:760-230-2253
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55252207R00000X, 208M00000X
390200000X
CAA163669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program