Healthcare Provider Details

I. General information

NPI: 1205400660
Provider Name (Legal Business Name): SONAL JAIPRAKASH PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE RM 202
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER 14 MEDICAL PARK, SUITE 400
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 937-272-4976
  • Fax:
Mailing address:
  • Phone: 803-434-6155
  • Fax: 803-434-6979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL86167
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: