MEDICARE: KEYA 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	PA9118038	FL

General Provider Information

NPI Number	:	1356111603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYA PATEL PA-C

Provider Business Mailing Address
First Line	:	8855 IMMOKALEE RD UNIT 11
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8855 IMMOKALEE RD UNIT 11
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3928
Country	:	US
Telephone Number	:	201-704-6202
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “ KEYA PATEL PA-C” Practice Location

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