Provider Demographics
NPI:1376070292
Name:PATEL, SHALINI (DMD)
Entity type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3010
Mailing Address - Country:US
Mailing Address - Phone:631-521-1334
Mailing Address - Fax:
Practice Address - Street 1:410 W LANCASTER AVE STE 106
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1588
Practice Address - Country:US
Practice Address - Phone:610-646-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028255001223P0221X
NY0610271223P0221X
PADS0440191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty