Provider Demographics
NPI:1083791172
Name:PATEL, DAYA J (MD)
Entity Type:Individual
Prefix:MRS
First Name:DAYA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1543 KINGSLEY AVE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-264-1958
Mailing Address - Fax:904-264-1677
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:BLDG 9
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-264-1958
Practice Address - Fax:904-264-1677
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0052941208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE30575Medicare UPIN