Provider Demographics
NPI:1881038644
Name:SIDHPURA, MONALI PATEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:MONALI
Middle Name:PATEL
Last Name:SIDHPURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONALI
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5600
Mailing Address - Country:US
Mailing Address - Phone:631-365-2259
Mailing Address - Fax:
Practice Address - Street 1:1400 RIVER PL
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5600
Practice Address - Country:US
Practice Address - Phone:631-365-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76957208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist