Provider Demographics
NPI:1780939041
Name:DESAI, SHIVALI P (OD)
Entity type:Individual
Prefix:DR
First Name:SHIVALI
Middle Name:P
Last Name:DESAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4101 CAMPUS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5077
Mailing Address - Country:US
Mailing Address - Phone:704-234-1930
Mailing Address - Fax:833-233-6851
Practice Address - Street 1:2015 RANDOLPH RD STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1200
Practice Address - Country:US
Practice Address - Phone:704-334-2020
Practice Address - Fax:833-231-6851
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1721152W00000X
NC2400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist