Provider Demographics
NPI:1891176244
Name:PATEL, SHIVANI S (MD)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1447 YORK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6017
Mailing Address - Country:US
Mailing Address - Phone:672-141-1716
Mailing Address - Fax:410-337-5107
Practice Address - Street 1:1447 YORK RD STE 102
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:667-214-1171
Practice Address - Fax:410-337-5107
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD87020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD87020OtherLICENSE