Provider Demographics
NPI:1043264443
Name:DESAI, NITA S (MD)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:S
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17171
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0171
Mailing Address - Country:US
Mailing Address - Phone:901-877-7897
Mailing Address - Fax:901-877-7991
Practice Address - Street 1:3000 GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2205
Practice Address - Country:US
Practice Address - Phone:901-268-8620
Practice Address - Fax:901-877-7991
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000177682084A0401X
TN177682084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00054180OtherRAILROAD MEDICARE
TN3079276Medicaid
TN3079271Medicare PIN
TNP00054180OtherRAILROAD MEDICARE