Provider Demographics
NPI:1811028954
Name:PATEL, SHAKUNTALA (MD)
Entity Type:Individual
Prefix:
First Name:SHAKUNTALA
Middle Name:
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 1:3601 4TH ST STOP 7208
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-7208
Mailing Address - Country:US
Mailing Address - Phone:806-743-2844
Mailing Address - Fax:806-743-1071
Practice Address - Street 1:3601 4TH ST STOP 7208
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-7208
Practice Address - Country:US
Practice Address - Phone:806-743-2844
Practice Address - Fax:806-743-1071
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0508390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program