Provider Demographics
NPI:1689281693
Name:DESAI, PRIYA N (PA-C)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:N
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ROUTE 59 STE 306
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5208
Mailing Address - Country:US
Mailing Address - Phone:845-357-1821
Mailing Address - Fax:
Practice Address - Street 1:222 ROUTE 59 STE 306
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5208
Practice Address - Country:US
Practice Address - Phone:845-357-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00563400363A00000X
NY024731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant