Healthcare Provider Details

I. General information

NPI: 1154247997
Provider Name (Legal Business Name): MR. KUNJ DINESHKUMAR PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N ANDREWS AVE
WILTON MANORS FL
33311-3914
US

IV. Provider business mailing address

1905 N ANDREWS AVE
WILTON MANORS FL
33311-3914
US

V. Phone/Fax

Practice location:
  • Phone: 954-581-5400
  • Fax:
Mailing address:
  • Phone: 954-581-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number136933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: