Provider Demographics
NPI:1306947528
Name:PATEL, BHAVINI S (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:BHAVINI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0014
Mailing Address - Country:US
Mailing Address - Phone:978-494-0075
Mailing Address - Fax:978-494-4141
Practice Address - Street 1:555 TURNPIKE ST
Practice Address - Street 2:SUITE #31
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5923
Practice Address - Country:US
Practice Address - Phone:978-494-0075
Practice Address - Fax:978-494-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2073133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0492OtherMEDICARE