Basic Information
| Provider Information | |||||||||
| NPI: | 1033504451 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATEL | ||||||||
| FirstName: | DEVASHRI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1963 FRUITRIDGE ST | ||||||||
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| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335106006 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1305 LAKELAND HILLS BLVD | ||||||||
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| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636882334 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | ME148412 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No ID Information.