Provider Demographics
NPI:1700379187
Name:JOHNSTON, SHIVALI DIPAM PATEL (DO)
Entity Type:Individual
Prefix:
First Name:SHIVALI
Middle Name:DIPAM PATEL
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 RODNEY RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9715
Mailing Address - Country:US
Mailing Address - Phone:717-846-8791
Mailing Address - Fax:
Practice Address - Street 1:1550 RODNEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9715
Practice Address - Country:US
Practice Address - Phone:717-846-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018524207Q00000X
PAOS020918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine