Provider Demographics
NPI:1114037462
Name:KASHYAP PATEL MD PA
Entity Type:Organization
Organization Name:KASHYAP PATEL MD PA
Other - Org Name:A-ONE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KASHYAP
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-615-8971
Mailing Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3199
Mailing Address - Country:US
Mailing Address - Phone:386-615-8971
Mailing Address - Fax:386-677-9685
Practice Address - Street 1:325 CLYDE MORRIS BLVD STE 340
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3199
Practice Address - Country:US
Practice Address - Phone:386-615-8971
Practice Address - Fax:386-677-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270963500Medicaid
FL270963500Medicaid
FLI20460Medicare UPIN