Basic Information
Provider Information
NPI: 1952560005
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: TRUSHA
MiddleName: GOVINDJI
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GOVINDJI
OtherFirstName: TRUSHA
OtherMiddleName: JAYANTI
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 918025
Address2:  
City: ORLANDO
State: FL
PostalCode: 328918025
CountryCode: US
TelephoneNumber: 3522738610
FaxNumber: 3522738612
Practice Location
Address1: 2821 PROCTOR RD
Address2:  
City: SARASOTA
State: FL
PostalCode: 342316443
CountryCode: US
TelephoneNumber: 3522738610
FaxNumber: 3522738612
Other Information
ProviderEnumerationDate: 06/04/2008
LastUpdateDate: 10/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207L00000XME112691FLY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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