Provider Demographics
NPI:1326821380
Name:PATEL, AMIE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E MOSHOLU PKWY N APT 3J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2612
Mailing Address - Country:US
Mailing Address - Phone:646-436-2075
Mailing Address - Fax:
Practice Address - Street 1:25 E MOSHOLU PKWY N APT 3J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2612
Practice Address - Country:US
Practice Address - Phone:646-436-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311295363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health