Provider Demographics
NPI:1740959618
Name:DESAI, RUCHI PRATIK (PA-C)
Entity type:Individual
Prefix:
First Name:RUCHI
Middle Name:PRATIK
Last Name:DESAI
Suffix:
Gender:F
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 1:2017 GIOVANNI CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7106
Mailing Address - Country:US
Mailing Address - Phone:919-815-8998
Mailing Address - Fax:
Practice Address - Street 1:2017 GIOVANNI CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7106
Practice Address - Country:US
Practice Address - Phone:919-815-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007944363A00000X
MDC0008091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant