Provider Demographics
NPI:1548382344
Name:PATEL, NIYATI
Entity type:Individual
Prefix:
First Name:NIYATI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 N ROCKY POINT DR
Mailing Address - Street 2:SUITE 1000 - CREDENTIALING
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1421
Mailing Address - Country:US
Mailing Address - Phone:813-288-1999
Mailing Address - Fax:813-289-7549
Practice Address - Street 1:5000 US HIGHWAY 17
Practice Address - Street 2:SUITE 4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-8231
Practice Address - Country:US
Practice Address - Phone:904-215-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice