Provider Demographics
NPI:1124125695
Name:DESAI, JYOTI DIVYAKANT
Entity type:Individual
Prefix:MRS
First Name:JYOTI
Middle Name:DIVYAKANT
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JYOTI
Other - Middle Name:SURESHCHANDRA
Other - Last Name:UPADHYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3900 WOODLAND AVE
Mailing Address - Street 2:PHILADELPHIA VA MEDICAL CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4551
Mailing Address - Country:US
Mailing Address - Phone:215-823-5800
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:PHILADELPHIA VA MEDICAL CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11478600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner