Provider Demographics
NPI:1730561267
Name:DESAI, TRISHLA AMIT (MD)
Entity type:Individual
Prefix:DR
First Name:TRISHLA
Middle Name:AMIT
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 1:626 1ST AVE APT E11C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3915
Mailing Address - Country:US
Mailing Address - Phone:561-389-8605
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL SATILLA HEALTH
Practice Address - Street 2:1900 TEBEAU STREET
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:561-389-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN# 21111390200000X
GA79746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program