Basic Information
| Provider Information | |||||||||
| NPI: | 1205400660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SONAL | ||||||||
| MiddleName: | JAIPRAKASH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER | ||||||||
| Address2: | 14 MEDICAL PARK, SUITE 400 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346155 | ||||||||
| FaxNumber: | 8034346979 | ||||||||
| Practice Location | |||||||||
| Address1: | PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER | ||||||||
| Address2: | 14 MEDICAL PARK, SUITE 400 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346155 | ||||||||
| FaxNumber: | 8034346979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2021 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | LL86167 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.