Provider Demographics
NPI:1932163854
Name:PATEL, NANDINI ANILKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:NANDINI
Middle Name:ANILKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N WITCHDUCK RD STE G
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6217
Mailing Address - Country:US
Mailing Address - Phone:757-395-4585
Mailing Address - Fax:
Practice Address - Street 1:4501 N WITCHDUCK RD STE G
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6217
Practice Address - Country:US
Practice Address - Phone:757-395-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010424032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932163854Medicaid
E33625Medicare UPIN