Provider Demographics
NPI:1992538565
Name:PATEL, SHAMA (NP-C)
Entity type:Individual
Prefix:
First Name:SHAMA
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7172
Mailing Address - Country:US
Mailing Address - Phone:714-375-1122
Mailing Address - Fax:949-863-8581
Practice Address - Street 1:17822 BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7172
Practice Address - Country:US
Practice Address - Phone:714-375-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner