Basic Information
| Provider Information | |||||||||
| NPI: | 1467972380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHIVANI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 EAST ROAD | ||||||||
| Address2: | ST 3326 | ||||||||
| City: | HOUST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134862565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 31ST ST. | ||||||||
| Address2: | MS-22-117D | ||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547241768 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2017 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | S2144 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.