Provider Demographics
NPI:1053948109
Name:PATEL, ROSHNI VIREN (PA)
Entity type:Individual
Prefix:
First Name:ROSHNI
Middle Name:VIREN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7512 DR PHILLIPS BLVD STE 50
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5420
Mailing Address - Country:US
Mailing Address - Phone:407-602-7168
Mailing Address - Fax:407-245-8503
Practice Address - Street 1:1540 CITRUS MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-602-7168
Practice Address - Fax:407-245-8503
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9113115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant