Healthcare Provider Details

I. General information

NPI: 1831933654
Provider Name (Legal Business Name): JENISH SHRESTHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date: 03/21/2025
Reactivation Date: 09/22/2025

III. Provider practice location address

3601 4TH STREET, MAIL STOP 9901
LUBBOCK TX
79430
US

IV. Provider business mailing address

3601 4TH STREET, MAIL STOP 9901
LUBBOCK TX
79430
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2757
  • Fax: 806-743-1180
Mailing address:
  • Phone: 806-743-2757
  • Fax: 806-743-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: