Provider Demographics
NPI:1902039753
Name:PATEL, SUREKHA (MSN, ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUREKHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JAGGER CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3235
Mailing Address - Country:US
Mailing Address - Phone:631-258-9587
Mailing Address - Fax:
Practice Address - Street 1:1630 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5210
Practice Address - Country:US
Practice Address - Phone:631-242-6166
Practice Address - Fax:631-241-0728
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304131-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner