Basic Information
| Provider Information | |||||||||
| NPI: | 1790919868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH DESAI | ||||||||
| FirstName: | SEJAL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | SHAH | ||||||||
| OtherFirstName: | SEJAL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 38135 MARKET SQ | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335427505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139724444 | ||||||||
| FaxNumber: | 8139791600 | ||||||||
| Practice Location | |||||||||
| Address1: | 13602 N 46TH ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139724444 | ||||||||
| FaxNumber: | 8139791600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 276443 | NY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | ME115371 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.