Healthcare Provider Details

I. General information

NPI: 1205132735
Provider Name (Legal Business Name): NIRA K PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N THORNTON AVE
ORLANDO FL
32803-4003
US

IV. Provider business mailing address

86 W UNDERWOOD ST SUITE 202
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-398-6470
  • Fax: 407-894-6872
Mailing address:
  • Phone: 407-649-6876
  • Fax: 407-872-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN16339
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME120073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: