Healthcare Provider Details

I. General information

NPI: 1063655066
Provider Name (Legal Business Name): MANITA SHRESTHA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROAD ST STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

29749 PICANA LN FL 2
WESLEY CHAPEL FL
33543-6652
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax: 877-485-8918
Mailing address:
  • Phone: 917-538-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00230100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: