Provider Demographics
NPI:1740647676
Name:PATEL, KOMAL DILIPKUMAR (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KOMAL
Middle Name:DILIPKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 STATE ST APT 305
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2769
Mailing Address - Country:US
Mailing Address - Phone:704-965-2001
Mailing Address - Fax:
Practice Address - Street 1:111 GOOSE LN STE 1300
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-5101
Practice Address - Country:US
Practice Address - Phone:203-453-9192
Practice Address - Fax:203-453-0875
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7653363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner