Provider Demographics
NPI:1225510308
Name:DESAI, VAISHALI
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ADINA TER
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9591
Mailing Address - Country:US
Mailing Address - Phone:973-809-1694
Mailing Address - Fax:
Practice Address - Street 1:2001 US HIGHWAY 46 STE 310
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1315
Practice Address - Country:US
Practice Address - Phone:973-283-5640
Practice Address - Fax:973-607-4748
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00845400364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family