| Walnut Avenue Associates Pc | |
|
16 Walnut Ave Sw Roanoke VA 24016-4719 | |
| (540) 345-6468 | |
| (540) 345-3204 |
| Full Name | Walnut Avenue Associates Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 16 Walnut Ave Sw, Roanoke, Virginia |
| Authorized Official Name and Position | Jitendra S Desai (OWNER) |
| Authorized Official Contact | 5403456468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Walnut Avenue Associates Pc 16 Walnut Ave Sw Roanoke VA 24016-4719 Ph: (540) 345-6468 | Walnut Avenue Associates Pc 16 Walnut Ave Sw Roanoke VA 24016-4719 Ph: (540) 345-6468 |
| NPI Number | 1861583791 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4284736612 |
|---|---|
| Medicare Enrollment ID | O20070302000352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861583791 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jitendra S Desai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942281019 PECOS PAC ID: 6800998238 Enrollment ID: I20070302000397 |
| Provider Name | Michelle Whittaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841721891 PECOS PAC ID: 0840565289 Enrollment ID: I20171010003803 |
| Provider Name | Amaninder Kaur Grewal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467166355 PECOS PAC ID: 3173968849 Enrollment ID: I20240304003426 |
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