Provider Demographics
NPI:1053018051
Name:PATEL, KALINDI PREMILA
Entity type:Individual
Prefix:
First Name:KALINDI
Middle Name:PREMILA
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N MORGAN ST UNIT 1D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1721
Mailing Address - Country:US
Mailing Address - Phone:312-313-6125
Mailing Address - Fax:
Practice Address - Street 1:15835 SHADDOCK DR STE 130
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5778
Practice Address - Country:US
Practice Address - Phone:312-888-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024172363LP0808X
IL209.026963363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health