Provider Demographics
NPI:1609008028
Name:PATEL, SUJATA (RD, CDN, CCN)
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RD, CDN, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MERCER STREET
Mailing Address - Street 2:SUIT B 308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:203-863-3617
Mailing Address - Fax:203-863-4538
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:CENTER FOR INTEGRATIVE MEDICIN
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2759
Practice Address - Country:US
Practice Address - Phone:203-863-3615
Practice Address - Fax:203-863-4538
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000852133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000852OtherDEPARTMENT OF PUBLIC HEALTH