Provider Demographics
NPI:1184906810
Name:SHEKHAR DESAI MD LLC
Entity type:Organization
Organization Name:SHEKHAR DESAI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-543-5203
Mailing Address - Street 1:PO BOX 372913
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-0913
Mailing Address - Country:US
Mailing Address - Phone:321-543-5203
Mailing Address - Fax:321-777-2235
Practice Address - Street 1:311 LANSING ISLAND DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5106
Practice Address - Country:US
Practice Address - Phone:321-543-5203
Practice Address - Fax:321-777-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59178207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty