=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902858822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUART ONCOLOGY ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 07/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 SE OCEAN BLVD
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-276-7242
-----------------------------------------------------
Fax | 772-237-3109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 SE OCEAN BLVD
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-276-7242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PRASHANT R PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-276-7242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | ME0064712
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------