Provider Demographics
NPI:1558974113
Name:PATEL, KEENA ANEKA
Entity Type:Individual
Prefix:
First Name:KEENA
Middle Name:ANEKA
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 1:6663 SYLVAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6448
Mailing Address - Country:US
Mailing Address - Phone:407-459-2690
Mailing Address - Fax:
Practice Address - Street 1:7085 COUNTY ROAD 46A
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4700
Practice Address - Country:US
Practice Address - Phone:407-459-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist