Provider Demographics
NPI:1407841521
Name:PATEL, SHAILESH J (MD)
Entity type:Individual
Prefix:
First Name:SHAILESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-444-7057
Practice Address - Street 1:4724 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2339
Practice Address - Country:US
Practice Address - Phone:850-696-4000
Practice Address - Fax:850-444-7057
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24241207RH0003X
FLME71816207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261424300Medicaid
FL7666255OtherAETNA
FLP01428449OtherRR MEDICARE
FL373457OtherAVMED
FLE5565YOtherMEDICARE PTAN
FL1355791OtherCIGNA
AL109729Medicaid
FL200595OtherWELLCARE
AL102I835954OtherMEDICARE PTAN
FLE5565YOtherMEDICARE PTAN
FLH37442Medicare UPIN