Healthcare Provider Details

I. General information

NPI: 1548729304
Provider Name (Legal Business Name): PRIYA KIRANKANT PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 DR MARTIN LUTHER KING JR ST N
ST PETERSBURG FL
33701-2717
US

IV. Provider business mailing address

3750 26TH AVE N
ST PETERSBURG FL
33713-3414
US

V. Phone/Fax

Practice location:
  • Phone: 727-825-0111
  • Fax:
Mailing address:
  • Phone: 949-241-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME158553
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME158553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: