Provider Demographics
NPI:1528211042
Name:PATEL, LISA SUMANTLAL (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUMANTLAL
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 1:484 2ND AVE
Mailing Address - Street 2:APT. 8E , #41
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9154
Mailing Address - Country:US
Mailing Address - Phone:315-383-3816
Mailing Address - Fax:
Practice Address - Street 1:17010 VILESTA DRIVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6383
Practice Address - Country:US
Practice Address - Phone:813-903-3700
Practice Address - Fax:813-615-8337
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111281207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology