Healthcare Provider Details

I. General information

NPI: 1740286129
Provider Name (Legal Business Name): SHASHIN R DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHASHIN R DESAI M.D.

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W EAU GALLIE BLVD STE 200
MELBOURNE FL
32935-3166
US

IV. Provider business mailing address

2200 W EAU GALLIE BLVD STE 200
MELBOURNE FL
32935-3166
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-1500
  • Fax: 321-254-0400
Mailing address:
  • Phone: 321-255-1500
  • Fax: 321-254-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME58099
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME58099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: