Provider Demographics
NPI:1013375005
Name:SHRESTHA, UTSAV (BA)
Entity Type:Individual
Prefix:
First Name:UTSAV
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 S WESTERN AVE
Mailing Address - Street 2:STE. A-21
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4982
Mailing Address - Country:US
Mailing Address - Phone:405-703-8755
Mailing Address - Fax:
Practice Address - Street 1:9210 S WESTERN AVE
Practice Address - Street 2:STE. A-21
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4982
Practice Address - Country:US
Practice Address - Phone:405-703-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist