Provider Demographics
NPI:1114124112
Name:POKHAREL, SHRADHA (MD)
Entity Type:Individual
Prefix:
First Name:SHRADHA
Middle Name:
Last Name:POKHAREL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 KINGSLEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5174
Mailing Address - Country:US
Mailing Address - Phone:904-298-2113
Mailing Address - Fax:904-298-1922
Practice Address - Street 1:2021 KINGSLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:904-298-2113
Practice Address - Fax:904-298-1922
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107854207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003140199AMedicaid
FL149FMOtherBCBS
FL002671500Medicaid
FL149FMOtherBCBS
FL002671500Medicaid