Provider Demographics
NPI:1679980122
Name:PATEL, SUKESHI K (MD)
Entity Type:Individual
Prefix:
First Name:SUKESHI
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:904-642-6100
Mailing Address - Fax:904-642-5154
Practice Address - Street 1:4972 TOWN CENTER PKWY UNIT 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8596
Practice Address - Country:US
Practice Address - Phone:904-642-6100
Practice Address - Fax:904-642-5154
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142746208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105456700Medicaid