Provider Demographics
NPI:1770129629
Name:SMYRE, DRASTI PATEL (PA-C)
Entity type:Individual
Prefix:
First Name:DRASTI
Middle Name:PATEL
Last Name:SMYRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W MEETING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2205
Mailing Address - Country:US
Mailing Address - Phone:803-285-2041
Mailing Address - Fax:803-285-2097
Practice Address - Street 1:1029 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2205
Practice Address - Country:US
Practice Address - Phone:803-285-2041
Practice Address - Fax:803-285-2097
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3435363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical