Healthcare Provider Details

I. General information

NPI: 1730523176
Provider Name (Legal Business Name): SHIV CHETAN DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803
US

IV. Provider business mailing address

2415 N ORANGE AVE STE 182
ORLANDO FL
32804-5505
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME136731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: