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: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 WELLNESS WAY STE 130
ORLANDO FL
32832-7176
US

IV. Provider business mailing address

15815 SHADDOCK DR STE 130
WINTER GARDEN FL
34787-5773
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-0248
  • Fax: 407-604-6636
Mailing address:
  • Phone: 407-605-2321
  • Fax: 407-671-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: