Provider Demographics
NPI:1063483170
Name:PATEL, MONA PRAGNESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:PRAGNESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:861 OAKLEY SEAVER DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:352-394-7125
Mailing Address - Fax:352-294-2584
Practice Address - Street 1:861 OAKLEY SEAVER DR UNIT A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-394-7125
Practice Address - Fax:352-294-2584
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME709572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251421400Medicaid
FL251421400Medicaid