Provider Demographics
NPI:1558306688
Name:PATEL, JAYESH V (D O)
Entity Type:Individual
Prefix:
First Name:JAYESH
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 CHENEY HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6792
Mailing Address - Country:US
Mailing Address - Phone:321-269-0059
Mailing Address - Fax:321-269-9926
Practice Address - Street 1:2175 CHENEY HWY
Practice Address - Street 2:SUITE A
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6792
Practice Address - Country:US
Practice Address - Phone:321-269-0059
Practice Address - Fax:321-269-9926
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7701207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery