Healthcare Provider Details

I. General information

NPI: 1851691984
Provider Name (Legal Business Name): DEWANSHI PRAVIN PATEL RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4189 VETERANS MEMORIAL DR
BATAVIA NY
14020-1274
US

IV. Provider business mailing address

7017 37TH AVE
JACKSON HEIGHTS NY
11372-3922
US

V. Phone/Fax

Practice location:
  • Phone: 585-201-5598
  • Fax: 585-201-5599
Mailing address:
  • Phone: 718-565-5600
  • Fax: 718-565-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014375-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: