Healthcare Provider Details

I. General information

NPI: 1235229378
Provider Name (Legal Business Name): ANGELINE C.N. DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 HWY. 441 NORTH ECKERD YOUTH DEVELOPMENT CENTER
OKEECHOBEE FL
34972
US

IV. Provider business mailing address

7956 PLANTATION LAKES DR
PORT ST LUCIE FL
34986-3011
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-2174
  • Fax:
Mailing address:
  • Phone: 772-489-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME29224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: