MEDICARE: SANDRA P DESAI DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2882	FL
2	213E00000X	Podiatrist	PO2833	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104867050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA P DESAI DPM

Provider Business Mailing Address
First Line	:	12734 KENWOOD LN
Second Line	:	SUITE 44
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5666
Country	:	US
Telephone Number	:	239-936-2454
Fax Number	:	239-936-1974

Provider Business Practice Location Address
First Line	:	12734 KENWOOD LN
Second Line	:	SUITE 44
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5666
Country	:	US
Telephone Number	:	239-936-2454
Fax Number	:	239-936-1974

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LAURA TOADVINE
Credential	:
Telephone Number	:	239-936-2454

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/30/2011

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Directions to “SANDRA P DESAI DPM ” Practice Location

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