Basic Information
| Provider Information | |||||||||
| NPI: | 1740647676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | KOMAL | ||||||||
| MiddleName: | DILIPKUMAR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 STATE ST APT 305 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065112769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049652001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 GOOSE LN STE 1300 | ||||||||
| Address2: | |||||||||
| City: | GUILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064375101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034539192 | ||||||||
| FaxNumber: | 2034530875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2016 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 7653 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 7653 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.