Provider Demographics
NPI:1942658810
Name:PATEL, SHIVANI
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:PATEL
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 1:18200 E TENMILE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1368
Mailing Address - Country:US
Mailing Address - Phone:586-771-7500
Mailing Address - Fax:586-486-1700
Practice Address - Street 1:18200 E TENMILE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1368
Practice Address - Country:US
Practice Address - Phone:586-771-7500
Practice Address - Fax:586-486-1700
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist