Provider Demographics
NPI:1295945616
Name:PATEL, SANJEEV K (BS HONS)
Entity type:Individual
Prefix:MR
First Name:SANJEEV
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:BS HONS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 WESTOVER CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6239
Mailing Address - Country:US
Mailing Address - Phone:407-445-0400
Mailing Address - Fax:
Practice Address - Street 1:340 SOUTH SR 434 SUIT 1034
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-788-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02279600Medicaid