Provider Demographics
NPI:1548055536
Name:PATEL, MOHINI R (AGACNP- BC)
Entity type:Individual
Prefix:
First Name:MOHINI
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:AGACNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PETERBOROUGH ST APT 401
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4945
Mailing Address - Country:US
Mailing Address - Phone:603-973-3382
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE FL SHAPIRO9
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5491
Practice Address - Country:US
Practice Address - Phone:617-667-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2309356363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health