MEDICARE: MRS. VANDANA PATEL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9104643	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CZ091Z	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164748042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANDANA PATEL PA-C

Provider Business Mailing Address
First Line	:	9365 VIA MURANO CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5499
Country	:	US
Telephone Number	:	732-804-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 BETH STACEY BLVD
Second Line	:	SUITE 130
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-6074
Country	:	US
Telephone Number	:	239-369-4088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	01/20/2020

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Directions to “ MRS. VANDANA PATEL PA-C” Practice Location

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