Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD474452 | PA |
N | 208000000X | Pediatrician | ML60866223 | WA |
N | 2080P0210X | Pediatric Nephrologist | MT222214 | PA |
NPI | 1760986475 |
---|---|
Provider Name | Tara Sardesai |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 21/06/2021 |