Provider Demographics
NPI:1922548130
Name:PATEL, NITIKSHA (PA-C)
Entity Type:Individual
Prefix:
First Name:NITIKSHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 SMOKETOWN RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4722
Mailing Address - Country:US
Mailing Address - Phone:703-580-0181
Mailing Address - Fax:703-897-8763
Practice Address - Street 1:14010 SMOKETOWN RD
Practice Address - Street 2:SUITE 117
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4722
Practice Address - Country:US
Practice Address - Phone:703-580-0181
Practice Address - Fax:703-897-8763
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005650363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical