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Individual
SAMPADA RAJESH DESHPANDE
Active
Individual
SAMPADA RAJESH DESHPANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1196
KY
363A00000X
Physician Assistant
TC026
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TC026
TEMPORARY KY LICENSE
KY
Enumeration date
07/29/2009
Last updated
10/26/2010
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