Provider Demographics
NPI:1659367985
Name:PATEL, SHREYAS V (MD)
Entity Type:Individual
Prefix:
First Name:SHREYAS
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2912
Mailing Address - Country:US
Mailing Address - Phone:617-789-2696
Mailing Address - Fax:617-789-5177
Practice Address - Street 1:765 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2912
Practice Address - Country:US
Practice Address - Phone:617-789-2696
Practice Address - Fax:617-789-5177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60640208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3053156Medicaid
MAJ08290Medicare ID - Type Unspecified
MA3053156Medicaid