Provider Demographics
NPI:1285799429
Name:PATEL, USHA P (MD)
Entity type:Individual
Prefix:
First Name:USHA
Middle Name:P
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 1:999 N STONE ST STE A
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0800
Mailing Address - Country:US
Mailing Address - Phone:386-738-6804
Mailing Address - Fax:
Practice Address - Street 1:999 N STONE ST
Practice Address - Street 2:SUITEA
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0800
Practice Address - Country:US
Practice Address - Phone:386-738-6804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0395331000Medicaid