Healthcare Provider Details

I. General information

NPI: 1528211042
Provider Name (Legal Business Name): LISA SUMANTLAL PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17010 VILESTA DRIVE
LUTZ FL
33548-6383
US

IV. Provider business mailing address

484 2ND AVE APT. 8E , #41
NEW YORK NY
10016-9154
US

V. Phone/Fax

Practice location:
  • Phone: 813-903-3700
  • Fax: 813-615-8337
Mailing address:
  • Phone: 315-383-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME111281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: