Provider Demographics
NPI:1639557481
Name:PATEL, NIYOMI GANDHI (MD)
Entity Type:Individual
Prefix:
First Name:NIYOMI
Middle Name:GANDHI
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIYOMI
Other - Middle Name:
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8401 MEDICAL PLAZA DR STE 220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8700
Practice Address - Country:US
Practice Address - Phone:704-384-1570
Practice Address - Fax:704-384-1534
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107395208000000X
MA275549208000000X
NC2021-03281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics