Healthcare Provider Details

I. General information

NPI: 1043076060
Provider Name (Legal Business Name): MIRA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MOORE RD
KING OF PRUSSIA PA
19406-1228
US

IV. Provider business mailing address

7208 REDTOP RD
HUMMELSTOWN PA
17036-9556
US

V. Phone/Fax

Practice location:
  • Phone: 610-400-4344
  • Fax:
Mailing address:
  • Phone: 610-507-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC016823
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: