Provider Demographics
NPI:1992187082
Name:PATEL, SHRUTI A (DPM)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 SMOKETOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4723
Mailing Address - Country:US
Mailing Address - Phone:703-583-5959
Mailing Address - Fax:
Practice Address - Street 1:14010 SMOKETOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4723
Practice Address - Country:US
Practice Address - Phone:703-583-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006651390200000X
NJ25MD00341900213ES0103X
VA0103301290213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program