Provider Demographics
NPI:1528393667
Name:PATEL, SHEETAL MAYUR (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHEETAL
Middle Name:MAYUR
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PRIMACY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0213
Mailing Address - Country:US
Mailing Address - Phone:901-866-8812
Mailing Address - Fax:901-448-0401
Practice Address - Street 1:1301 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0213
Practice Address - Country:US
Practice Address - Phone:901-866-8812
Practice Address - Fax:901-448-0401
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL190295Medicaid
MO1528393667Medicaid
TN1530301Medicaid
AR194831001Medicaid
MS09524519Medicaid
GA0032179707AMedicaid