Provider Demographics
NPI:1497353999
Name:DESAI, KAUSHAR (APRN)
Entity Type:Individual
Prefix:
First Name:KAUSHAR
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAUSHAR
Other - Middle Name:M
Other - Last Name:KHATUMBRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CLINIC #459
Mailing Address - Street 2:2639 MAIN ST
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-659-1329
Mailing Address - Fax:
Practice Address - Street 1:CLINIC #459
Practice Address - Street 2:2639 MAIN ST
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-659-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTF10200328207R00000X
CT9333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine