Healthcare Provider Details

I. General information

NPI: 1548728033
Provider Name (Legal Business Name): PALAK PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11169 TRINITY BLVD
TRINITY FL
34655-4538
US

IV. Provider business mailing address

2705 W SAINT ISABEL ST
TAMPA FL
33607-6319
US

V. Phone/Fax

Practice location:
  • Phone: 727-877-0297
  • Fax: 727-877-0312
Mailing address:
  • Phone: 813-879-5795
  • Fax: 813-877-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number2023011012
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME171631
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036164218
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: