Basic Information
| Provider Information | |||||||||
| NPI: | 1427715663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHEENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6037 | ||||||||
| Address2: | |||||||||
| City: | WAUCONDA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600846037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475262151 | ||||||||
| FaxNumber: | 8475262017 | ||||||||
| Practice Location | |||||||||
| Address1: | 431 W LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAUCONDA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600842452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475262151 | ||||||||
| FaxNumber: | 8475262017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2021 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085008882 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.