Provider Demographics
NPI:1598262479
Name:DESAI, VISHAL SANJAY
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:SANJAY
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BRAMSON CT UNIT 301
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7953
Mailing Address - Country:US
Mailing Address - Phone:843-654-8250
Mailing Address - Fax:
Practice Address - Street 1:501 BRAMSON CT UNIT 301
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7953
Practice Address - Country:US
Practice Address - Phone:843-654-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPOD.740213ES0103X
PASC007160213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist