Provider Demographics
NPI:1033340757
Name:DESHPANDE, SAMPADA RAJESH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SAMPADA
Middle Name:RAJESH
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:800 ROSE STREET MN649
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY DIGESTIVE DISEASES
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-3555
Mailing Address - Fax:859-257-8860
Practice Address - Street 1:800 ROSE STREET MN649
Practice Address - Street 2:UNIVERSITY OF KENTUCKY DIGESTIVE DISEASES
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-3555
Practice Address - Fax:859-257-8860
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2010-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYTC026363A00000X
KYPA1196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTC026OtherTEMPORARY KY LICENSE