Provider Demographics
NPI:1932454709
Name:PATEL, SHEENA PRAVIN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SHEENA
Middle Name:PRAVIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3151 AIRWAY AVE STE G1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4624
Mailing Address - Country:US
Mailing Address - Phone:714-545-5550
Mailing Address - Fax:714-708-2588
Practice Address - Street 1:3151 AIRWAY AVE STE G1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4624
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:714-708-2588
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA21163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant