Healthcare Provider Details

I. General information

NPI: 1295962462
Provider Name (Legal Business Name): AJAY KISHOR DESAI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 GUNN HWY STE 100
TAMPA FL
33618-8720
US

IV. Provider business mailing address

1046 S FLORIDA AVE
LAKELAND FL
33803-1118
US

V. Phone/Fax

Practice location:
  • Phone: 813-840-4304
  • Fax: 813-948-3010
Mailing address:
  • Phone: 863-816-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberOS12568
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberOS12568
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS12568
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberOS12568
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberOS014712
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOS12568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: