Healthcare Provider Details

I. General information

NPI: 1508109588
Provider Name (Legal Business Name): ROSHNI PATEL MA, MHA, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35379 CRESCENT CREEK DR
ZEPHYRHILLS FL
33541-2948
US

IV. Provider business mailing address

35379 CRESCENT CREEK DR
ZEPHYRHILLS FL
33541-2948
US

V. Phone/Fax

Practice location:
  • Phone: 951-907-0669
  • Fax:
Mailing address:
  • Phone: 951-907-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12501
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY12501
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number22107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: