Provider Demographics
NPI:1275317075
Name:PATEL, PANKTI
Entity Type:Individual
Prefix:
First Name:PANKTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ALPINE DRIVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:DEWITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214
Mailing Address - Country:US
Mailing Address - Phone:678-285-8771
Mailing Address - Fax:
Practice Address - Street 1:117 ALPINE DRIVE
Practice Address - Street 2:SUITE #3
Practice Address - City:DEWITT
Practice Address - State:NY
Practice Address - Zip Code:13214
Practice Address - Country:US
Practice Address - Phone:678-285-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program