Healthcare Provider Details

I. General information

NPI: 1114838927
Provider Name (Legal Business Name): SAMANTHA GAIL PATEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W 86TH ST
INDIANAPOLIS IN
46260-2340
US

IV. Provider business mailing address

433 W 86TH ST
INDIANAPOLIS IN
46260-2340
US

V. Phone/Fax

Practice location:
  • Phone: 317-793-0865
  • Fax:
Mailing address:
  • Phone: 317-793-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28285258A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: