MEDICARE: KAJAL PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-80275	FL
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962015586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAJAL PATEL

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	5461 HILLANDALE DR STE 100
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-4842
Country	:	US
Telephone Number	:	470-361-2976
Fax Number	:	678-609-9577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	04/16/2025

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Directions to “ KAJAL PATEL ” Practice Location

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