Provider Demographics
NPI:1003685025
Name:PATEL, SHIVANI (CPNP-PC)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1405 FRANKLIN GTWY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8705
Mailing Address - Country:US
Mailing Address - Phone:770-951-5400
Mailing Address - Fax:770-702-1312
Practice Address - Street 1:1405 FRANKLIN GTWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8705
Practice Address - Country:US
Practice Address - Phone:770-951-5400
Practice Address - Fax:770-702-1312
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN300775163W00000X
GA202325129363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse