Provider Demographics
NPI:1790088128
Name:PATEL, SHRADDHA N (PA-C)
Entity Type:Individual
Prefix:
First Name:SHRADDHA
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHRADDHA
Other - Middle Name:G
Other - Last Name:MAHADEVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:774 CHRISTIANA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4221
Mailing Address - Country:US
Mailing Address - Phone:302-731-3017
Mailing Address - Fax:302-292-8102
Practice Address - Street 1:774 CHRISTIANA RD STE 201
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4221
Practice Address - Country:US
Practice Address - Phone:302-731-3017
Practice Address - Fax:302-292-8102
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000809363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherBLUE CROSS BLUE SHIELD GROUP