Healthcare Provider Details

I. General information

NPI: 1083073092
Provider Name (Legal Business Name): CHIRAG V DESAI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 R G SKINNER PKWY
JACKSONVILLE FL
32256-9655
US

IV. Provider business mailing address

9838 OLD BAYMEADOWS RD
JACKSONVILLE FL
32256-8101
US

V. Phone/Fax

Practice location:
  • Phone: 904-955-8434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 103568
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 103568
License Number StateFL

VIII. Authorized Official

Name: DR. CHIRAG V DESAI
Title or Position: OWNER/AUTHORIZED MEMBER
Credential: MD
Phone: 904-955-8434