Provider Demographics
NPI:1609193747
Name:DESAI, PURVI (MSLDRD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MSLDRD
Other - Prefix:
Other - First Name:PURVI
Other - Middle Name:
Other - Last Name:PANDYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSLDRD
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4005
Mailing Address - Fax:512-901-3905
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4005
Practice Address - Fax:512-901-3905
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL836153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01409924OtherRRMC PTAN
TXP01409924OtherRRMC PTAN