Healthcare Provider Details

I. General information

NPI: 1619400637
Provider Name (Legal Business Name): SONAL ASHOK PATEL RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCHANT ST
SHARON MA
02067-1662
US

IV. Provider business mailing address

1 MERCHANT ST
SHARON MA
02067-1662
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-4944
  • Fax:
Mailing address:
  • Phone: 781-784-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT84630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: