Provider Demographics
NPI:1144243825
Name:DESAI, SHIVANI NARENDRA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHIVANI
Middle Name:NARENDRA
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHIVANI
Other - Middle Name:N
Other - Last Name:KHARIWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:361 ANNELISE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2065
Mailing Address - Country:US
Mailing Address - Phone:860-620-9337
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant