Provider Demographics
NPI:1386838803
Name:DESI, JANICE (PA)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:DESI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4777
Mailing Address - Country:US
Mailing Address - Phone:860-685-8951
Mailing Address - Fax:860-685-8945
Practice Address - Street 1:410 SAYBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4711
Practice Address - Country:US
Practice Address - Phone:860-685-8951
Practice Address - Fax:860-685-8945
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2008-09-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical