Healthcare Provider Details

I. General information

NPI: 1871966846
Provider Name (Legal Business Name): DITI DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SPRUCE ST BSMT WEST
PHILADELPHIA PA
19106-4022
US

IV. Provider business mailing address

700 SPRUCE ST BSMT WEST
PHILADELPHIA PA
19106-4022
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3264
  • Fax: 215-829-8044
Mailing address:
  • Phone: 215-829-3264
  • Fax: 215-829-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19124
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057943
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: