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General NPI Number Information
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NPI Number | 1881928810
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Entity Type | Individual
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Provider Name | NISHA LALIT PATEL P.A.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 1074 SOUTHERN AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-1766
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Country | US
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Telephone | 910-489-1326
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Fax | 866-488-6433
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Provider Business Mailing Address
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Address Line | PO BOX 727
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City | STEDMAN
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State | NC
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Zip | 28391-0727
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Country | US
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Telephone | 910-489-1326
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Fax | 866-488-6433
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA054010
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-03858
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License Number State | NC
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