Provider Demographics
NPI:1215776430
Name:DESAI, ROSHNI SUDHIR (PA-C)
Entity type:Individual
Prefix:
First Name:ROSHNI
Middle Name:SUDHIR
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43698 VINTNERS PLACE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1333
Mailing Address - Country:US
Mailing Address - Phone:586-506-0544
Mailing Address - Fax:
Practice Address - Street 1:43698 VINTNERS PLACE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1333
Practice Address - Country:US
Practice Address - Phone:586-506-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY031485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant