Provider Demographics
NPI:1700097912
Name:PATEL, SHEFALI (OD)
Entity type:Individual
Prefix:DR
First Name:SHEFALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 QUEENSGATE DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-6408
Mailing Address - Country:US
Mailing Address - Phone:770-863-9874
Mailing Address - Fax:
Practice Address - Street 1:3625 DALLAS HWY SW
Practice Address - Street 2:SUITE 660
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5912
Practice Address - Country:US
Practice Address - Phone:770-590-8951
Practice Address - Fax:770-590-8135
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist