Provider Demographics
NPI:1881369445
Name:PATI, PAUL ANANDA
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANANDA
Last Name:PATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1413
Mailing Address - Country:US
Mailing Address - Phone:504-421-3718
Mailing Address - Fax:
Practice Address - Street 1:12589 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2501
Practice Address - Country:US
Practice Address - Phone:985-764-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily