Nicolas Junior Desjardins, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA6469 Issued in MA

Practice address

96 Summer St Apt 1
Somerville, MA 02143-2707

Phone

(617) 834-8784

NPI assigned

Mar 3, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1144722372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 SUMMER ST APT 1",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021432707",
            "telephone_number": "617-834-8784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 SUMMER ST APT 1",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021432707",
            "telephone_number": "617-834-8784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESJARDINS",
        "first_name": "NICOLAS",
        "middle_name": "JUNIOR",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-03",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA6469",
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "MA",
            "license": "PA6469",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MA",
            "license": "PA6469",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6469",
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "MA",
            "license": "PA6469",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Derosa, OTR/L
• Nikita Desai, WHNP-BC
• Prium Deshmukh, M.D.
• Manouchka Desir
• Nadege Desir, LPN
• Andrew X Destefano, DPT
• Chrysnell Destina, EMT-B
• Giselle Devane
• Emily Devlin
• Marriann Dew, PA-C

• Surgical Physician Assistant in Somerville, MA
• Providers in Somerville, MA by specialty
• Surgical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.