Provider Demographics
NPI:1952746133
Name:PATEL, SHRUTI (MD)
Entity type:Individual
Prefix:MISS
First Name:SHRUTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 SUGARLOAF PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:4850 SUGARLOAF PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2860
Practice Address - Country:US
Practice Address - Phone:678-490-8300
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0074274207R00000X
WAMD61621803207R00000X
NJ25MA09839100207R00000X
AZ74589207R00000X
NC2024-03662207R00000X
GA87261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine