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General NPI Number Information
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NPI Number | 1053875120
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Entity Type | Individual
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Provider Name | SMITA PATEL CST
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 2435 FOREST DR
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City | COLUMBIA
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State | SC
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Zip | 29204-2026
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Country | US
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Telephone | 803-638-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 GARNER LN
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City | COLUMBIA
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State | SC
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Zip | 29210-8301
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Country | US
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Telephone | 803-665-6691
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 074831
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License Number State | SC
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