Provider Demographics
NPI:1508278599
Name:PATANI, NIDHI
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:PATANI
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 1:11529 FLINTS GROVE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2470
Mailing Address - Country:US
Mailing Address - Phone:904-728-7583
Mailing Address - Fax:
Practice Address - Street 1:11529 FLINTS GROVE LN
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2470
Practice Address - Country:US
Practice Address - Phone:904-728-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional