Provider Demographics
NPI:1992820344
Name:PATEL, JAYLATA MADHUSUDAN (MD)
Entity type:Individual
Prefix:
First Name:JAYLATA
Middle Name:MADHUSUDAN
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:P.O. BOX 8970
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-8970
Mailing Address - Country:US
Mailing Address - Phone:419-517-1758
Mailing Address - Fax:419-517-1399
Practice Address - Street 1:5151 MONROE ST
Practice Address - Street 2:#200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3462
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:419-479-7039
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0527682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
04393OtherPARAMOUNT HEALTH CARE
242482-000OtherMAGELLAN HEALTH SERVICES
OH0655465Medicaid
OH2014961Medicare PIN
A17304Medicare UPIN