Healthcare Provider Details

I. General information

NPI: 1255406302
Provider Name (Legal Business Name): BHAVNABEN B PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BHAVNA B PATEL MD

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 NORTH STONE STREET SUITE A
DELAND FL
32720
US

IV. Provider business mailing address

999 NORTH STONE STREET SUITE A
DELAND FL
32720
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 NumberME48873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: