Provider Demographics
NPI:1982081287
Name:PATEL, SHRADDHA (RDN)
Entity Type:Individual
Prefix:MS
First Name:SHRADDHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37439 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4910
Mailing Address - Country:US
Mailing Address - Phone:510-566-9937
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSS AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-212-7877
Practice Address - Fax:408-212-7882
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1053627133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered