Healthcare Provider Details

I. General information

NPI: 1043864168
Provider Name (Legal Business Name): NIYATI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 GULFPORT BLVD S
SOUTH PASADENA FL
33707-2108
US

IV. Provider business mailing address

10622 PARK PLACE DR
LARGO FL
33778-3402
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-9655
  • Fax:
Mailing address:
  • Phone: 360-622-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN24458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: