Provider Demographics
NPI:1841350949
Name:DESAI, SHOBHANA A (MD)
Entity type:Individual
Prefix:DR
First Name:SHOBHANA
Middle Name:A
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Practice Address - Street 2:111 S. 11TH STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:215-923-9519
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035125L2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01272366Medicaid
NJ2388804Medicaid
MD6908918Medicaid
149528SAJMedicare PIN
C31950Medicare UPIN