=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164711453
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BHUMIKA PATEL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2011
-----------------------------------------------------
Last Update Date | 08/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 DR MARTIN LUTHER KING JR ST N
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33704-4222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-873-1177
-----------------------------------------------------
Fax | 631-444-2493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DEPT. OF MEDICINE HSC T16 STONY BROOK UNIVERSITY HOSPITAL
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11794-8160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-444-4000
-----------------------------------------------------
Fax | 631-444-2493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0201X
-----------------------------------------------------
Taxonomy Name | Pediatric Allergy/Immunology Physician
-----------------------------------------------------
License Number | ME124286
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------