Healthcare Provider Details

I. General information

NPI: 1780170746
Provider Name (Legal Business Name): AMISHA DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 100
HOLLYWOOD FL
33021-5424
US

IV. Provider business mailing address

1150 N 35TH AVE STE 100
HOLLYWOOD FL
33021-5424
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-2234
  • Fax:
Mailing address:
  • Phone: 954-265-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberOS17606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: