Provider Demographics
NPI:1306012166
Name:KESANI, SHAILY PATEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILY
Middle Name:PATEL
Last Name:KESANI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4471 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1795
Mailing Address - Country:US
Mailing Address - Phone:972-316-4555
Mailing Address - Fax:972-316-4550
Practice Address - Street 1:4471 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1795
Practice Address - Country:US
Practice Address - Phone:972-316-4555
Practice Address - Fax:972-316-4550
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2015-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.127261207N00000X
TXQ3213207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213247008OtherMEDICARE PTAN