Healthcare Provider Details

I. General information

NPI: 1598609703
Provider Name (Legal Business Name): SUJALKUMAR PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 SHEPHERD FARM DR
WEST CHESTER OH
45069-1128
US

IV. Provider business mailing address

5047 AINSLEY DR
MASON OH
45040-6621
US

V. Phone/Fax

Practice location:
  • Phone: 513-942-9500
  • Fax:
Mailing address:
  • Phone: 513-208-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number00420004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: