Provider Demographics
NPI:1699769505
Name:PATEL, DAKSHA R (MD)
Entity type:Individual
Prefix:
First Name:DAKSHA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1313
Mailing Address - Country:US
Mailing Address - Phone:813-234-1315
Mailing Address - Fax:813-234-3354
Practice Address - Street 1:1213 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1313
Practice Address - Country:US
Practice Address - Phone:813-234-1315
Practice Address - Fax:813-234-3354
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME51002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046756100Medicaid
FLC4E756100Medicaid
FLA63536Medicare UPIN