Provider Demographics
NPI:1700555695
Name:PATEL, SHIVANI (MA)
Entity Type:Individual
Prefix:MS
First Name:SHIVANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 135H
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6127
Mailing Address - Country:US
Mailing Address - Phone:978-927-0172
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 135H
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6127
Practice Address - Country:US
Practice Address - Phone:978-927-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1447289103OtherNPI