Provider Demographics
NPI:1184136772
Name:PATEL, SHREYAS DILIP
Entity type:Individual
Prefix:DR
First Name:SHREYAS
Middle Name:DILIP
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SHREYAS
Other - Middle Name:DILIPBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 WHITWORTH LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8614
Mailing Address - Country:US
Mailing Address - Phone:919-413-2191
Mailing Address - Fax:
Practice Address - Street 1:200 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3013
Practice Address - Country:US
Practice Address - Phone:919-383-5591
Practice Address - Fax:919-384-1832
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist