Healthcare Provider Details

I. General information

NPI: 1053732370
Provider Name (Legal Business Name): ANUP SHRESTHA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2014
Last Update Date: 01/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 CRANBERRY DR
MOUNT HOPE WV
25880-9168
US

IV. Provider business mailing address

753 CRANBERRY DR
MOUNT HOPE WV
25880-9168
US

V. Phone/Fax

Practice location:
  • Phone: 304-877-8482
  • Fax:
Mailing address:
  • Phone: 304-877-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01775
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: