Healthcare Provider Details

I. General information

NPI: 1558821207
Provider Name (Legal Business Name): TILISHA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TILISHA PERSAUD

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

PO BOX 320848
TAMPA FL
33679-2848
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5551
  • Fax: 813-916-2944
Mailing address:
  • Phone: 855-421-2733
  • Fax: 813-916-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME158029
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME158029
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01099889A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: