Provider Demographics
NPI:1649929282
Name:PATEL, MARISSA (DO)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 5TH STREET SOUTH
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-767-3445
Mailing Address - Fax:727-767-8804
Practice Address - Street 1:600 5TH STREET SOUTH
Practice Address - Street 2:SUITE 3100
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-767-3445
Practice Address - Fax:727-767-8804
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program