Healthcare Provider Details

I. General information

NPI: 1790717304
Provider Name (Legal Business Name): KINNARI P DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 60TH STREET CT W
BRADENTON FL
34209-6609
US

IV. Provider business mailing address

2310 60TH STREET CT W
BRADENTON FL
34209-6609
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-4993
  • Fax: 941-795-2905
Mailing address:
  • Phone: 941-792-4993
  • Fax: 941-795-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME107712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: