Basic Information
| Provider Information | |||||||||
| NPI: | 1841350949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | SHOBHANA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NEMOURS CHILDRENS CLINIC | ||||||||
| Address2: | P.O. BOX 404112 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043903610 | ||||||||
| FaxNumber: | 9042885890 | ||||||||
| Practice Location | |||||||||
| Address1: | THOMAS JEFFERSON UNIVERSITY HOSPITAL | ||||||||
| Address2: | 111 S. 11TH STREET | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556000 | ||||||||
| FaxNumber: | 2159239519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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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 | 2080N0001X | MD035125L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01272366 | 05 | NY | MEDICAID | 2388804 | 05 | NJ | MEDICAID | 6908918 | 05 | MD | MEDICAID |