Healthcare Provider Details

I. General information

NPI: 1003801598
Provider Name (Legal Business Name): NEHA D PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 W GRANADA BLVD
ORMOND BEACH FL
32174-5914
US

IV. Provider business mailing address

1245 W GRANADA BLVD
ORMOND BEACH FL
32174-5914
US

V. Phone/Fax

Practice location:
  • Phone: 386-317-9055
  • Fax:
Mailing address:
  • Phone: 386-317-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00104600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: