Basic Information
Provider Information
NPI: 1508006776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: DONIKA
MiddleName:  
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 1200 N ELM ST
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274011004
CountryCode: US
TelephoneNumber: 3368327000
FaxNumber:  
Practice Location
Address1: 301 E WENDOVER AVE
Address2: SUITE 211
City: GREENSBORO
State: NC
PostalCode: 274011230
CountryCode: US
TelephoneNumber: 3368323070
FaxNumber: 3368323075
Other Information
ProviderEnumerationDate: 03/02/2009
LastUpdateDate: 09/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400X34.010814OHN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2084N0400X2014-01279NCY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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