Healthcare Provider Details

I. General information

NPI: 1063624971
Provider Name (Legal Business Name): SANDIP AMRUT PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 TANGLEWOOD DR
SARASOTA FL
34239-6518
US

IV. Provider business mailing address

1174 VIA VERDE # 270
SAN DIMAS CA
91773-4401
US

V. Phone/Fax

Practice location:
  • Phone: 310-494-4000
  • Fax:
Mailing address:
  • Phone: 310-494-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME164465
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberP55999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: