Basic Information
| Provider Information | |||||||||
| NPI: | 1174940886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHRINAL | ||||||||
| MiddleName: | SURYAKANT | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10300 S CRATER RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238057328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047325710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238059274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047655000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2014 | ||||||||
| LastUpdateDate: | 03/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0110004496 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.