Healthcare Provider Details

I. General information

NPI: 1609957786
Provider Name (Legal Business Name): NEEL RAJENDRA DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 13TH ST SW
LARGO FL
33770-3127
US

IV. Provider business mailing address

417 HARBOR DR S
INDIAN ROCKS BEACH FL
33785-3118
US

V. Phone/Fax

Practice location:
  • Phone: 727-581-8706
  • Fax:
Mailing address:
  • Phone: 843-810-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME 102683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: