Provider Demographics
NPI:1861842148
Name:DESAI, SHRADDHA (MD)
Entity type:Individual
Prefix:
First Name:SHRADDHA
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 1:311 STEVENS DR APT 104
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4535
Mailing Address - Country:US
Mailing Address - Phone:443-872-9184
Mailing Address - Fax:
Practice Address - Street 1:14961 W BELL RD STE 175
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3220
Practice Address - Country:US
Practice Address - Phone:623-242-9830
Practice Address - Fax:623-249-5181
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ68177207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program