Provider Demographics
NPI:1639721657
Name:SHRESTHA, SANJIVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJIVANI
Middle Name:
Last Name:SHRESTHA
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 1:1830 E MONUMENT ST STE 416
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0020
Mailing Address - Country:US
Mailing Address - Phone:443-927-3140
Mailing Address - Fax:410-367-2258
Practice Address - Street 1:1830 E MONUMENT ST STE 416
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0020
Practice Address - Country:US
Practice Address - Phone:443-927-3140
Practice Address - Fax:410-367-2258
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program