Provider Demographics
NPI:1154561264
Name:DESAI, ANISHA K (LIC AC)
Entity type:Individual
Prefix:
First Name:ANISHA
Middle Name:K
Last Name:DESAI
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WYSEFERRY CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9600
Mailing Address - Country:US
Mailing Address - Phone:919-389-1420
Mailing Address - Fax:
Practice Address - Street 1:100 WYSEFERRY CT
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-9600
Practice Address - Country:US
Practice Address - Phone:919-389-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232113171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist