MEDICARE: SHEKHAR DESAI MD LLC

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	207X00000X	Orthopaedic Surgery Physician	ME59178	FL

General Provider Information

NPI Number	:	1184906810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEKHAR DESAI MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 372913
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-0913
Country	:	US
Telephone Number	:	321-543-5203
Fax Number	:	321-777-2235

Provider Business Practice Location Address
First Line	:	311 LANSING ISLAND DR
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-5106
Country	:	US
Telephone Number	:	321-543-5203
Fax Number	:	321-777-2235

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHEKHAR DESAI
Credential	:	M.D.
Telephone Number	:	321-543-5203

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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