Provider Demographics
NPI:1588824031
Name:MEHTA, DIPALI SANDIP (AA)
Entity Type:Individual
Prefix:
First Name:DIPALI
Middle Name:SANDIP
Last Name:MEHTA
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TECHNOLOGY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-5008
Mailing Address - Country:US
Mailing Address - Phone:828-771-5222
Mailing Address - Fax:828-771-5253
Practice Address - Street 1:1781 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3862
Practice Address - Country:US
Practice Address - Phone:910-609-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100000163367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1000-00163OtherNORTH CAROLINA ANESTHESIOLOGIST ASSISTANT LICENSE