Basic Information
| Provider Information | |||||||||
| NPI: | 1942566567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHEEL | ||||||||
| MiddleName: | JAYENDRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 PARK ST N STE 1017 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446570 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 7TH ST S STE 560 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278207714 | ||||||||
| FaxNumber: | 7272026455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD.207905 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | ME136305 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100218800 | 05 | FL | MEDICAID | N166U | 01 | FL | BCBS FL | OTHER | K8436 | 01 | FL | MEDICARE | OTHER | KX143 | 01 | FL | MEDICARE | OTHER |