Healthcare Provider Details

I. General information

NPI: 1710503776
Provider Name (Legal Business Name): JAY SUNIL PATEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 S ARAPEEN DR
SALT LAKE CITY UT
84108-1218
US

IV. Provider business mailing address

PO BOX 841208
LOS ANGELES CA
90084-1208
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-7575
  • Fax: 801-585-8113
Mailing address:
  • Phone: 801-587-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number14226885-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61476622
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: