Provider Demographics
NPI:1952375735
Name:DESAI, ANSUYA (MD)
Entity Type:Individual
Prefix:
First Name:ANSUYA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 CHINCOTEAGUE WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7116
Mailing Address - Country:US
Mailing Address - Phone:512-244-3783
Mailing Address - Fax:
Practice Address - Street 1:1709 CHINCOTEAGUE WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7116
Practice Address - Country:US
Practice Address - Phone:512-244-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG58342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043267603Medicaid
TX8R8852OtherBLUE CROSS BLUE SHIELD
TX043267603Medicaid
D97311Medicare UPIN