Healthcare Provider Details

I. General information

NPI: 1679525653
Provider Name (Legal Business Name): CENTER FOR AESTHETIC PLASTIC SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17222 HOSPITAL BLVD STE 346
BROOKSVILLE FL
34601-8925
US

IV. Provider business mailing address

17222 HOSPITAL BLVD STE 346
BROOKSVILLE FL
34601-8925
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-3334
  • Fax: 352-796-3323
Mailing address:
  • Phone: 352-796-3334
  • Fax: 352-796-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME79778
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME73174
License Number StateFL

VIII. Authorized Official

Name: UTPALKUMAR PATEL
Title or Position: OWNER
Credential: M.D., PHD
Phone: 352-796-3334