Provider Demographics
NPI:1003801598
Name:PATEL, NEHA D (PA-C)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:D
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 1:1245 W GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5914
Mailing Address - Country:US
Mailing Address - Phone:386-317-9055
Mailing Address - Fax:
Practice Address - Street 1:1245 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5914
Practice Address - Country:US
Practice Address - Phone:386-317-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00104600363AM0700X
FLPA9109904363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7093403Medicaid
NJ7093403Medicaid
NJP87843Medicare UPIN
NJ7093403Medicaid