=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154803310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHRADA BHATTARAI PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2018
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 PASTEUR DR
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-723-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 PASTEUR DR
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-723-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | P55881
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 55881
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------