Healthcare Provider Details

I. General information

NPI: 1194801571
Provider Name (Legal Business Name): DELAND PEDIATRIC ASSOCIATES M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N STONE ST SUITE A
DELAND FL
32720-0800
US

IV. Provider business mailing address

999 N STONE ST SUITE A
DELAND FL
32720-0800
US

V. Phone/Fax

Practice location:
  • Phone: 386-738-6804
  • Fax: 386-943-4046
Mailing address:
  • Phone: 386-738-6804
  • Fax: 386-943-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. BHAVNABEN B PATEL
Title or Position: PRESIDENT
Credential:
Phone: 386-738-6804