Healthcare Provider Details

I. General information

NPI: 1497168926
Provider Name (Legal Business Name): VIJAY C SHRESTHA C.S.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2984 KINCAID DR
WALDORF MD
20603-5784
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-7095
  • Fax: 202-444-7856
Mailing address:
  • Phone: 240-383-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA0134
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: