Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036.117753 | IL |
NPI | 1053568246 |
---|---|
Provider Name | Shivani Desai |
First Address | Greenville, SC 29615-6739 |
Second Address | Greenville, SC 29615-6739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.1177753 | ILLINOIS LICENSE (01) | IL |