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General NPI Number Information
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NPI Number | 1235229378
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Entity Type | Individual
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Provider Name | ANGELINE C.N. DESAI M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7200 HWY. 441 NORTH ECKERD YOUTH DEVELOPMENT CENTER
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-763-2174
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Fax |
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Provider Business Mailing Address
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Address Line | 7956 PLANTATION LAKES DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-3011
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Country | US
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Telephone | 772-489-5852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME29224
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License Number State | FL
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