=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548055536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHINI R PATEL AGACNP- BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 BROOKLINE AVE FL SHAPIRO9
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02215-5491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-667-1293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 PETERBOROUGH ST APT 401
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02215-4945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-973-3382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2309356
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------