Provider Demographics
NPI:1497085930
Name:DESAI, DIMPLE RAHUL (PA-C)
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:RAHUL
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-782-1234
Mailing Address - Fax:
Practice Address - Street 1:38051 MARKET SQ
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7504
Practice Address - Country:US
Practice Address - Phone:813-782-1234
Practice Address - Fax:813-355-5066
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN38341246Z00000X
FLPA9105309363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01080597OtherR& R MEDICARE
FLCT719W - PASCOMedicare PIN
FLP01080597OtherR& R MEDICARE