Healthcare Provider Details

I. General information

NPI: 1699160689
Provider Name (Legal Business Name): KALYANI DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 OAK LEAF DR APT 1114
SILVER SPRING MD
20901-1389
US

IV. Provider business mailing address

11235 OAK LEAF DR APT 1114
SILVER SPRING MD
20901-1389
US

V. Phone/Fax

Practice location:
  • Phone: 914-320-8715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA000106
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: