Provider Demographics
NPI:1740286129
Name:DESAI, SHASHIN R (MD)
Entity type:Individual
Prefix:DR
First Name:SHASHIN
Middle Name:R
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHASHIN
Other - Middle Name:R
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3166
Mailing Address - Country:US
Mailing Address - Phone:321-255-1500
Mailing Address - Fax:321-254-0400
Practice Address - Street 1:2200 W EAU GALLIE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3166
Practice Address - Country:US
Practice Address - Phone:321-255-1500
Practice Address - Fax:321-254-0400
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58099207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051342300Medicaid
FLE70814Medicare UPIN
FL11430XMedicare PIN