Provider Demographics
NPI:1053775635
Name:PATEL, CHETAN SHAILESHKUMAR (NP-C)
Entity type:Individual
Prefix:
First Name:CHETAN
Middle Name:SHAILESHKUMAR
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 1:171 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-4405
Mailing Address - Country:US
Mailing Address - Phone:520-723-7726
Mailing Address - Fax:
Practice Address - Street 1:171 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-4405
Practice Address - Country:US
Practice Address - Phone:520-723-7726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ141674Medicaid