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General NPI Number Information
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NPI Number | 1033504451
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Entity Type | Individual
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Provider Name | DEVASHRI PATEL
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Gender | Female
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 1305 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-4542
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Country | US
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Telephone | 863-688-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 1963 FRUITRIDGE ST
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City | BRANDON
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State | FL
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Zip | 33510-6006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | ME148412
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License Number State | FL
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