Healthcare Provider Details

I. General information

NPI: 1336536994
Provider Name (Legal Business Name): SANJAY PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 E CACTUS RD STE 130
SCOTTSDALE AZ
85254-3545
US

IV. Provider business mailing address

3438 E KERRY LN
PHOENIX AZ
85050-6309
US

V. Phone/Fax

Practice location:
  • Phone: 623-526-5359
  • Fax:
Mailing address:
  • Phone: 859-420-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number008976
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04272
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: