Basic Information
| Provider Information | |||||||||
| NPI: | 1376604538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHRITI | ||||||||
| MiddleName: | BHARAT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465888 | ||||||||
| FaxNumber: | 7574465918 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465888 | ||||||||
| FaxNumber: | 7574465918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | 0101249921 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1376604538 | 01 | VA | OPTIMA BEHAVIORAL HEALTH | OTHER | 1376604538 | 01 | VA | UNITED BEHAVIORAL HEALTH | OTHER | 5918068 | 05 | NC | MEDICAID | PAR | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | PAR | 01 | VA | CIGNA BEHAVIORAL HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 1376604538 | 01 | VA | MANAGED HEALTH NETWORK | OTHER | 600713825 | 01 | VA | MAGELLAN HEALTH SERVICES | OTHER | 1376604538 | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTY HEALTH NETWORK | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | CORVEL | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 1376604538 | 05 | VA | MEDICAID | 438224 | 01 | VA | ANTHEM BEHAVIORAL HEALTH | OTHER | PAR | 01 | VA | VALUE OPTIONS | OTHER | PAR | 01 | VA | AETNA | OTHER |