Provider Demographics
NPI:1669427720
Name:PATEL, BEENA SAMIR (MD)
Entity type:Individual
Prefix:
First Name:BEENA
Middle Name:SAMIR
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6306
Mailing Address - Country:US
Mailing Address - Phone:386-456-2080
Mailing Address - Fax:386-575-5089
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:386-456-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME106121OtherSTATE LICENSE
NY229928OtherSTATE LICENSE NUMBER
NY331125879OtherTAX ID # FOR ORGANIZATION
NY215AC1Medicare ID - Type UnspecifiedMEDICARE
NYI02564Medicare UPIN