Healthcare Provider Details

I. General information

NPI: 1679970057
Provider Name (Legal Business Name): SAHEEL PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

2710 FAIT AVE
BALTIMORE MD
21224-3834
US

V. Phone/Fax

Practice location:
  • Phone: 408-821-0686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR199591
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR199591
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: