Provider Demographics
NPI:1467601732
Name:DESAI, AUNISHA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AUNISHA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WYOMING AVENUE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-714-3333
Mailing Address - Fax:570-338-3993
Practice Address - Street 1:445 WYOMING AVENUE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-714-3333
Practice Address - Fax:570-338-3993
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1084218363AM0700X
PAMA053713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical