Healthcare Provider Details

I. General information

NPI: 1194220418
Provider Name (Legal Business Name): SANDIP JITENDRA PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE
SAINT CLOUD FL
34769-4137
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-891-2941
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-891-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME158117
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME158117
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME158117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: