Provider Demographics
NPI:1629721808
Name:PATEL, SHIVANI
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S BLOOMINGDALE RD STE 11
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1216
Mailing Address - Country:US
Mailing Address - Phone:847-466-5420
Mailing Address - Fax:847-466-5856
Practice Address - Street 1:125 S BLOOMINGDALE RD STE 11
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1216
Practice Address - Country:US
Practice Address - Phone:847-466-5420
Practice Address - Fax:847-466-5856
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist