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General NPI Number Information
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NPI Number | 1861010811
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Entity Type | Individual
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Provider Name | MEDHA PATEL DESAI
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 2600 TAMARACK AVE STE 200
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-5560
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Country | US
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Telephone | 860-646-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 215 GEORGETOWN DR
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City | GLASTONBURY
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State | CT
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Zip | 06033-2348
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Country | US
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Telephone | 860-995-8292
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9868
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 145723
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License Number State | CT
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