Healthcare Provider Details

I. General information

NPI: 1295641538
Provider Name (Legal Business Name): NISHITA D. PATEL,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 N WICKHAM RD STE 105
MELBOURNE FL
32940-7503
US

IV. Provider business mailing address

6474 MODERN DURAN DR
MELBOURNE FL
32940-2832
US

V. Phone/Fax

Practice location:
  • Phone: 650-391-7585
  • Fax:
Mailing address:
  • Phone: 650-391-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NISHITA DIPAKKUMAR PATEL
Title or Position: MANAGER
Credential: DDS
Phone: 650-391-7585