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General NPI Number Information
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NPI Number | 1104867050
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Entity Type | Organization
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Legal Business Name | SANDRA P DESAI DPM
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 12734 KENWOOD LN SUITE 44
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City | FORT MYERS
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State | FL
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Zip | 33907-5666
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Country | US
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Telephone | 239-936-2454
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Fax | 239-936-1974
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Provider Business Mailing Address
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Address Line | 12734 KENWOOD LN SUITE 44
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City | FORT MYERS
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State | FL
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Zip | 33907-5666
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Country | US
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Telephone | 239-936-2454
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Fax | 239-936-1974
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURA TOADVINE
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Credential |
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Telephone | 239-936-2454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2882
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2833
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License Number State | FL
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