Provider Demographics
NPI:1013007053
Name:DIABETES & ENDOCRINOLOGY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINOLOGY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHRESTHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-461-0821
Mailing Address - Street 1:1301 PLANTATION ISLAND DR.
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080
Mailing Address - Country:US
Mailing Address - Phone:904-461-0821
Mailing Address - Fax:904-461-0823
Practice Address - Street 1:1301 PLANTATION ISLAND DR.
Practice Address - Street 2:SUITE 203A
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080
Practice Address - Country:US
Practice Address - Phone:904-461-0821
Practice Address - Fax:904-461-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN