Healthcare Provider Details

I. General information

NPI: 1033504451
Provider Name (Legal Business Name): DEVASHRI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 LAKELAND HILLS BLVD
LAKELAND FL
33805-4542
US

IV. Provider business mailing address

1963 FRUITRIDGE ST
BRANDON FL
33510-6006
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-2334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME148412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: