Provider Demographics
NPI:1558354175
Name:DESAI, DEVYANI N (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVYANI
Middle Name:N
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 DEBUEL RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5444
Mailing Address - Country:US
Mailing Address - Phone:813-404-7980
Mailing Address - Fax:863-413-3083
Practice Address - Street 1:1835 GILMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3017
Practice Address - Country:US
Practice Address - Phone:863-248-3300
Practice Address - Fax:863-413-3083
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010478112084P0800X
FLME548732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057537200Medicaid
FL14238OtherBLUE CROSS BLUE SHIELD
MI1558354175Medicaid
A78331Medicare UPIN