Healthcare Provider Details

I. General information

NPI: 1164041489
Provider Name (Legal Business Name): ELENA SUZANNE PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N CASWELL RD
CHARLOTTE NC
28204-2403
US

IV. Provider business mailing address

335 N CASWELL RD
CHARLOTTE NC
28204-2403
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-7980
  • Fax: 704-384-7985
Mailing address:
  • Phone: 704-384-7980
  • Fax: 704-384-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101028595
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.162146
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-01492
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: