Healthcare Provider Details

I. General information

NPI: 1679199962
Provider Name (Legal Business Name): VANISABEN PATEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S HARBOR CITY BLVD STE 110
MELBOURNE FL
32901-1906
US

IV. Provider business mailing address

709 S HARBOR CITY BLVD STE 110
MELBOURNE FL
32901-1906
US

V. Phone/Fax

Practice location:
  • Phone: 321-499-4646
  • Fax: 321-270-9449
Mailing address:
  • Phone: 321-499-4646
  • Fax: 321-270-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO4369
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4369
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4369
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO4369
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO4369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: