Provider Demographics
NPI:1063624971
Name:PATEL, SANDIP AMRUT (MD)
Entity type:Individual
Prefix:
First Name:SANDIP
Middle Name:AMRUT
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 E FOOTHILL BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1221
Mailing Address - Country:US
Mailing Address - Phone:310-494-4000
Mailing Address - Fax:
Practice Address - Street 1:3485 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6518
Practice Address - Country:US
Practice Address - Phone:310-494-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP55999282N00000X
FLME164465208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No282N00000XHospitalsGeneral Acute Care Hospital