Individual Healthcare Provider
Mira Desai, AGPCNP
Provider's NPPES record last updated: June 6, 2025
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1538559190
- Primary Specialty
- Nurse Practitioner — Gerontology
- Practice Location
- Stone Mountain, Georgia
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 20, 2026, 10:27 PM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Nurse Practitioner
Gerontology
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LG0600X Nurse Practitioner
Adult Health
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LA2200X
Provider-Reported License Information
- Nurse Practitioner (Illinois)
- 277.002161
- Nurse Practitioner (Georgia)
- RN309281
- Nurse Practitioner (Rhode Island)
- APRN03074
- Nurse Practitioner (Connecticut)
- 13875
- Nurse Practitioner (Virginia)
- 0001299163
Practice Locations
Practice Location
1825 Rockbridge Rd Ste 15b
Stone Mountain, Georgia 30087-3306
Phone: (470) 444-3134
Additional Practice Location
2000 N Main St Ste A
Waterbury, Connecticut 06704-2364
Phone: (203) 951-8306
Additional Practice Location
3621 Aramingo Ave Ste 5c
Philadelphia, Pennsylvania 19134-4607
Phone: (215) 444-7472
Additional Practice Location
2240 E 53rd St # B-1
Indianapolis, Indiana 46220-3479
Phone: (317) 933-7047
Additional Practice Location
300 Quaker Ln # C2-4
Warwick, Rhode Island 02886-0159
Phone: (401) 233-5051
Additional Practice Location
11260 E Jefferson Ave
Detroit, Michigan 48214-3320
Phone: (313) 749-0148
Fax: (313) 263-3298
Additional Practice Location
3046 127th St
Blue Island, Illinois 60406-1827
Phone: (708) 377-7920
Fax: (708) 930-0414
Additional Practice Location
5246 Chamberlayne Rd
Richmond, Virginia 23227-2950
Phone: (804) 913-7029
Record Information
- Enumeration Date
- February 3, 2015
- Provider's NPPES Record Last Updated
- June 6, 2025
- Certification Date
- June 6, 2025
- NPISignal NPPES Dataset
- August 2026
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