Provider Demographics
NPI:1467673947
Name:PATEL, NISHA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 NORTH WOLFE ROAD
Mailing Address - Street 2:APT# 415
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085
Mailing Address - Country:US
Mailing Address - Phone:213-675-4064
Mailing Address - Fax:
Practice Address - Street 1:1990 FRUITDALE AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-998-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29905171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor