Provider Demographics
NPI:1912970997
Name:PATEL, SHAUNAK (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 TURNPIKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2358
Mailing Address - Fax:814-768-3119
Practice Address - Street 1:809 TURNPIKE AVENUE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1232
Practice Address - Country:US
Practice Address - Phone:814-768-2358
Practice Address - Fax:814-768-3119
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001141701Medicaid
PA044540OtherMEDICARE GROUP PIN
DE008033H10Medicare ID - Type Unspecified
DE003297I23Medicare PIN
DE0001141701Medicaid
PA154366Medicare PIN