Provider Demographics
NPI:1700776432
Name:DESAI, VIDHI K (FNP-BC)
Entity type:Individual
Prefix:
First Name:VIDHI
Middle Name:K
Last Name:DESAI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PAWTUCKET BLVD UNIT 12
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1063
Mailing Address - Country:US
Mailing Address - Phone:978-844-7730
Mailing Address - Fax:
Practice Address - Street 1:1215 PAWTUCKET BLVD UNIT 12
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1063
Practice Address - Country:US
Practice Address - Phone:978-844-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2025037427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily