Healthcare Provider Details

I. General information

NPI: 1013411313
Provider Name (Legal Business Name): NISA S DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST STE 300
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

2140 W 68TH ST STE 305
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-4107
  • Fax: 305-822-5086
Mailing address:
  • Phone: 305-822-4107
  • Fax: 305-822-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME180537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: