Provider Demographics
NPI:1174899058
Name:PATEL, BHAIRAVI GUNVANT (MSED CCC-SLP)
Entity type:Individual
Prefix:
First Name:BHAIRAVI
Middle Name:GUNVANT
Last Name:PATEL
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 GULF BLVD
Mailing Address - Street 2:APT 505
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-3938
Mailing Address - Country:US
Mailing Address - Phone:518-253-1187
Mailing Address - Fax:
Practice Address - Street 1:1820 SHORE DR S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4601
Practice Address - Country:US
Practice Address - Phone:727-851-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist