Provider Demographics
NPI:1952864282
Name:PATEL, NISHA (RD, CSP)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1920 E CAMBRIDGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1462
Practice Address - Country:US
Practice Address - Phone:602-933-0965
Practice Address - Fax:602-933-4610
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1004X
AZ940660133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric