Provider Demographics
NPI:1124283700
Name:PATEL, SHETAL M (PHD)
Entity type:Individual
Prefix:DR
First Name:SHETAL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:MAIL CODE 116A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-642-3783
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:MAIL CODE 116A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-642-3783
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY21938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical