MEDICARE: SONAL PATEL PRASAD M.D

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	2084P0804X	Child & Adolescent Psychiatry Physician	Q3771	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0800X	Psychiatry Physician	Q3771	TX

General Provider Information

NPI Number	:	1851680300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONAL PATEL PRASAD M.D

Provider Business Mailing Address
First Line	:	DEPARTMENT OF PSYCHIATRY UT SOUTHWESTERN
Second Line	:	5323 HARRY HINES BLVD
City	:	DALLAS
State	:	TX
Zip	:	75390-8589
Country	:	US
Telephone Number	:	214-456-1383
Fax Number	:	214-456-1383

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF PSYCHIATRY UT SOUTHWESTERN
Second Line	:	5323 HARRY HINES BLVD
City	:	DALLAS
State	:	TX
Zip	:	75390-8589
Country	:	US
Telephone Number	:	214-456-1383
Fax Number	:	214-456-1383

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	12/14/2018

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