Provider Demographics
NPI:1659472611
Name:DESAI, SNEHAL (MD)
Entity Type:Individual
Prefix:
First Name:SNEHAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:850-390-4540
Mailing Address - Fax:850-390-4540
Practice Address - Street 1:23 MACK BAYOU LOOP
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-2606
Practice Address - Country:US
Practice Address - Phone:850-390-4540
Practice Address - Fax:850-390-4540
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME151567207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113739900Medicaid
NVI03725Medicare UPIN
NV1659472611Medicaid