Healthcare Provider Details

I. General information

NPI: 1962640946
Provider Name (Legal Business Name): SUDITI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

2505 ANTHEM VILLAGE DR SUITE E-134
HENDERSON NV
89052-5505
US

V. Phone/Fax

Practice location:
  • Phone: 702-401-4202
  • Fax:
Mailing address:
  • Phone: 702-401-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO01457
License Number StateNV

VIII. Authorized Official

Name: DR. SUJAY L PATEL
Title or Position: PHYSICIAN
Credential: DO
Phone: 702-401-4202