Healthcare Provider Details

I. General information

NPI: 1346933918
Provider Name (Legal Business Name): PRANAV SHRESTHA NEPALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 STEVENS MILL RD STE O
MATTHEWS NC
28104-6111
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-9090
  • Fax: 704-316-9095
Mailing address:
  • Phone: 704-510-8000
  • Fax: 704-510-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-02599
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351051237
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: