Provider Demographics
NPI:1679199962
Name:PATEL, VANISABEN (DPM)
Entity Type:Individual
Prefix:
First Name:VANISABEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15815 SHADDOCK DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5773
Mailing Address - Country:US
Mailing Address - Phone:407-605-2321
Mailing Address - Fax:407-671-4155
Practice Address - Street 1:10016 WELLNESS WAY STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7176
Practice Address - Country:US
Practice Address - Phone:407-650-0248
Practice Address - Fax:407-604-6636
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4369213E00000X, 213EP1101X, 213ES0000X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3410470OtherWELLCARE
FL15856328OtherCAQH
FL00008498716002OtherUNITED HEALTHCARE
FL118141300Medicaid
FLNU6MDOtherFL BLUE BCBS