Provider Demographics
NPI:1700494853
Name:PATEL, NIKITA PRAMOD (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:PRAMOD
Last Name:PATEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:502-805-1511
Practice Address - Street 1:199 HENSLEE DR.
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:615-652-1082
Practice Address - Fax:615-577-5654
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2024-02-27
Deactivation Date:2024-02-19
Deactivation Code:
Reactivation Date:2024-02-23
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TN7897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician