Healthcare Provider Details

I. General information

NPI: 1144293374
Provider Name (Legal Business Name): SHILPA DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PINE DR
STE GENEVIEVE MO
63670-1456
US

IV. Provider business mailing address

PO BOX 366
STE GENEVIEVE MO
63670-0366
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-4455
  • Fax:
Mailing address:
  • Phone: 573-883-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number106729
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier54563
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerHEALTHCARE USA
# 2
Identifier999556
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerCOMMUNITY CARE PLUS
# 3
Identifier54563
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerGHP
# 4
Identifier5700498
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerAETNA
# 5
Identifier12-09211
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerUHC
# 6
Identifier208722801
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 7
Identifier109713
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBCBS
# 8
Identifier336573
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerHEALTHLINK
# 9
Identifier430915730DES
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMERCY HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: