Provider Demographics
NPI:1174940886
Name:PATEL, SHRINAL SURYAKANT (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SHRINAL
Middle Name:SURYAKANT
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7328
Mailing Address - Country:US
Mailing Address - Phone:804-732-5710
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9274
Practice Address - Country:US
Practice Address - Phone:804-765-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004496363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical