Healthcare Provider Details

I. General information

NPI: 1316799844
Provider Name (Legal Business Name): ANJALI SANJAY DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 11/26/2024
Certification Date:
Deactivation Date: 11/11/2024
Reactivation Date: 11/26/2024

III. Provider practice location address

240 HOSPITAL ROAD
WHITESBURG KY
41858
US

IV. Provider business mailing address

714 JENKINS ROAD APT 5
WHITESBURG KY
41858
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-3500
  • Fax:
Mailing address:
  • Phone: 606-633-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: