Healthcare Provider Details

I. General information

NPI: 1396489811
Provider Name (Legal Business Name): NITAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 N LANDING RD STE 100
VIRGINIA BEACH VA
23456-3460
US

IV. Provider business mailing address

2521 N LANDING RD STE 100
VIRGINIA BEACH VA
23456-3460
US

V. Phone/Fax

Practice location:
  • Phone: 757-430-9448
  • Fax:
Mailing address:
  • Phone: 804-387-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401417934
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: