Provider Demographics
NPI:1932098803
Name:PATEL, SHIVANIBEN JITENDRABHAI
Entity type:Individual
Prefix:
First Name:SHIVANIBEN
Middle Name:JITENDRABHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5102
Mailing Address - Country:US
Mailing Address - Phone:212-335-1466
Mailing Address - Fax:212-486-8334
Practice Address - Street 1:1198 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5102
Practice Address - Country:US
Practice Address - Phone:212-335-1466
Practice Address - Fax:212-486-8334
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054278-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist