Provider Demographics
NPI:1013482447
Name:PATEL, NIRAJ BALDEV (PA-C)
Entity Type:Individual
Prefix:
First Name:NIRAJ
Middle Name:BALDEV
Last Name:PATEL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1240 EAGLES LANDING PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5173
Mailing Address - Country:US
Mailing Address - Phone:770-389-3855
Mailing Address - Fax:770-474-8078
Practice Address - Street 1:1110 NIKKI VIEW DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4868
Practice Address - Country:US
Practice Address - Phone:813-444-5567
Practice Address - Fax:813-444-5569
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2021-09-14
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Provider Licenses
StateLicense IDTaxonomies
FLPA9113390363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical