NPI Code Detail JSON Logo

1104867050 NPI number — SANDRA P DESAI DPM

NPI Number: 1104867050
Health Care Provider/Practitioner: SANDRA P DESAI DPM

Information about “1104867050” NPI (SANDRA P DESAI DPM) exists in 1104867050 in HTML format HTML  |  1104867050 in plain Text format TXT  |  1104867050 in PDF (Portable Document Format) PDF  |  1104867050 in an XML format XML  formats.

NPI Number : 1104867050 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104867050",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SANDRA P DESAI DPM",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12734 KENWOOD LN",
    "SecondLineMailingAddress": "SUITE 44",
    "MailingAddressCityName": "FORT MYERS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33907-5666",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-936-2454",
    "MailingAddressFaxNumber": "239-936-1974",
    "FirstLinePracticeLocationAddress": "12734 KENWOOD LN",
    "SecondLinePracticeLocationAddress": "SUITE 44",
    "PracticeLocationAddressCityName": "FORT MYERS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33907-5666",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-936-2454",
    "PracticeLocationAddressFaxNumber": "239-936-1974",
    "EnumerationDate": "06/10/2006",
    "LastUpdateDate": "08/30/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TOADVINE",
    "AuthorizedOfficialFirstName": "LAURA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OFFICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "239-936-2454",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "PO2882",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "PO2833",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.