Healthcare Provider Details

I. General information

NPI: 1548064595
Provider Name (Legal Business Name): PUJA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MEYRAN AVE
PITTSBURGH PA
15213
US

IV. Provider business mailing address

128 HARDWOOD DR
VENETIA PA
15367-2318
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-1100
  • Fax:
Mailing address:
  • Phone: 724-554-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRTO000643
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3746748
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: