Provider Demographics
NPI:1568830529
Name:PATEL, AJAY BANKIM (NP)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:BANKIM
Last Name:PATEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6026 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3899
Mailing Address - Country:US
Mailing Address - Phone:919-865-8710
Mailing Address - Fax:919-977-9760
Practice Address - Street 1:6026 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3899
Practice Address - Country:US
Practice Address - Phone:919-865-8710
Practice Address - Fax:919-977-9760
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5008864363LP0808X
NC259751363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health