Provider Demographics
NPI:1245702026
Name:DESAI, ROSHNI PRADIP (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ROSHNI
Middle Name:PRADIP
Last Name:DESAI
Suffix:
Gender:
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 1:3003 CLAIRE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6667
Mailing Address - Country:US
Mailing Address - Phone:904-204-6585
Mailing Address - Fax:850-390-7195
Practice Address - Street 1:125 16TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5211
Practice Address - Country:US
Practice Address - Phone:206-326-3000
Practice Address - Fax:206-326-2785
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006819363A00000X
WAPA61276656363A00000X
FLPA9119243363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant