Provider Demographics
NPI:1912744764
Name:PATEL, NISHI (PA-C)
Entity type:Individual
Prefix:
First Name:NISHI
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:PA-C
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:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:
Practice Address - Street 1:170 MEDICAL PARK RD STE 201
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8541
Practice Address - Country:US
Practice Address - Phone:704-664-4679
Practice Address - Fax:704-761-6988
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-15192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant