Provider Demographics
NPI:1881928810
Name:PATEL, NISHA LALIT (PA)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:LALIT
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-0727
Mailing Address - Country:US
Mailing Address - Phone:910-489-1326
Mailing Address - Fax:866-488-6433
Practice Address - Street 1:1074 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-1766
Practice Address - Country:US
Practice Address - Phone:910-489-1326
Practice Address - Fax:866-488-6433
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054010363AM0700X
NC0010-03858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical