Provider Demographics
NPI:1972262079
Name:PATEL, SHILPA K (MS, CNS)
Entity Type:Individual
Prefix:MRS
First Name:SHILPA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 W GREENLEAF DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9772
Mailing Address - Country:US
Mailing Address - Phone:847-863-4570
Mailing Address - Fax:
Practice Address - Street 1:1896 W GREENLEAF DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-9772
Practice Address - Country:US
Practice Address - Phone:847-863-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCNS18322133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education