Provider Demographics
NPI:1790276194
Name:PATEL, ANISHA (MS)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2789 BRIDLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7661
Mailing Address - Country:US
Mailing Address - Phone:678-372-6339
Mailing Address - Fax:
Practice Address - Street 1:22 BUFORD VILLAGE WAY STE 229
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8846
Practice Address - Country:US
Practice Address - Phone:678-482-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist