1992795009 NPI number — SHEKHAR S DESAI MD

Table of content: SHEKHAR S DESAI MD (NPI 1992795009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992795009 NPI number — SHEKHAR S DESAI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESAI
Provider First Name:
SHEKHAR
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992795009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 GATEWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-952-4445
Provider Business Mailing Address Fax Number:
321-952-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 BABCOCK ST NE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
PALM BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32905-4612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-952-4445
Provider Business Practice Location Address Fax Number:
321-952-3081
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME59178 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200037431 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4339774 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 053065400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4234237004 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12128 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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