Provider Demographics
NPI:1598262479
Name:DESAI, VISHAL SANJAY
Entity type:Individual
Prefix:
First Name:VISHAL
Middle Name:SANJAY
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2107
Mailing Address - Country:US
Mailing Address - Phone:215-257-6315
Mailing Address - Fax:844-873-2227
Practice Address - Street 1:601 LAWN AVENUE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2107
Practice Address - Country:US
Practice Address - Phone:215-257-6315
Practice Address - Fax:844-873-2227
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007160213E00000X
SCPOD.740213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist