MEDICARE: SHENIDA DESIR

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	363LA2100X	Acute Care Nurse Practitioner	111008379	FL
2	363LP2300X	Primary Care Nurse Practitioner	APRN11008379	FL
3	363LF0000X	Family Nurse Practitioner	APRN11008379	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	:	1730794280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENIDA DESIR

Provider Business Mailing Address
First Line	:	3893 NW 73RD TER UNIT 302
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2147
Country	:	US
Telephone Number	:	954-918-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	3893 NW 73RD TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2147
Country	:	US
Telephone Number	:	954-918-9903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	03/22/2022

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Directions to “ SHENIDA DESIR ” Practice Location

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