Provider Demographics
NPI:1922642180
Name:SHEATS, RAVEENA PATEL
Entity Type:Individual
Prefix:
First Name:RAVEENA
Middle Name:PATEL
Last Name:SHEATS
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 1:7465 LANCASTER PIKE STE J2
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9583
Mailing Address - Country:US
Mailing Address - Phone:302-312-0029
Mailing Address - Fax:
Practice Address - Street 1:7465 LANCASTER PIKE STE J2
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9583
Practice Address - Country:US
Practice Address - Phone:302-312-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0001806225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE101793061492Medicaid