Provider Demographics
NPI:1548430168
Name:DR. SANDHYA DESAI
Entity Type:Organization
Organization Name:DR. SANDHYA DESAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-826-0527
Mailing Address - Street 1:545 N RIVER ST.
Mailing Address - Street 2:SUITE # 230
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2643
Mailing Address - Country:US
Mailing Address - Phone:570-826-0527
Mailing Address - Fax:570-824-0688
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE # 230
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-826-0527
Practice Address - Fax:570-824-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120392Medicare PIN