Provider Demographics
NPI:1609895937
Name:DESAI, NILA (MDMPH)
Entity Type:Individual
Prefix:
First Name:NILA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MDMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 W CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1809
Mailing Address - Country:US
Mailing Address - Phone:407-836-2690
Mailing Address - Fax:407-836-2543
Practice Address - Street 1:832 W CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1809
Practice Address - Country:US
Practice Address - Phone:407-836-2690
Practice Address - Fax:407-836-2543
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045727208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035994700Medicaid
FLME0045727OtherMEDICAL LICENSE
FL04214XOtherMEDICAREPTAN
FL1609895937OtherNPI
FL359947Medicaid
FL359947Medicaid
AD 1234436OtherDEA NUMBER