Provider Demographics
NPI:1982226296
Name:SHRESTHA, SHIVANI (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
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 1:506 LENOX AVENUE, RM-13-106-MLK
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-1406
Mailing Address - Fax:212-939-1462
Practice Address - Street 1:506 LENOX AVENUE, RM-13-106-MLK
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-1406
Practice Address - Fax:212-939-1462
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2023-09-08
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-06-27
Provider Licenses
StateLicense IDTaxonomies
KY57610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine