Provider Demographics
NPI:1497168926
Name:SHRESTHA, VIJAY C (CSA)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:C
Last Name:SHRESTHA
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2984 KINCAID DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5784
Mailing Address - Country:US
Mailing Address - Phone:240-383-7035
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-7095
Practice Address - Fax:202-444-7856
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCSA0134246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant