Healthcare Provider Details

I. General information

NPI: 1053948109
Provider Name (Legal Business Name): ROSHNI VIREN PATEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

7512 DR PHILLIPS BLVD STE 50
ORLANDO FL
32819-5420
US

V. Phone/Fax

Practice location:
  • Phone: 407-602-7168
  • Fax: 407-245-8503
Mailing address:
  • Phone: 407-602-7168
  • Fax: 407-245-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: