Provider Demographics
NPI:1700013521
Name:DESAI, SHAUN CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:CHANDRA
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6420 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 4920
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7837
Mailing Address - Country:US
Mailing Address - Phone:301-896-3332
Mailing Address - Fax:301-530-2650
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 4920
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-896-3332
Practice Address - Fax:301-530-2650
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79917207YX0905X
MO2014008229207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD097422600Medicaid