Provider Demographics
NPI:1295060986
Name:SHRESTHA, ARCHANA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:ARCHANA
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 WATERFORD LAKES PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4501
Mailing Address - Country:US
Mailing Address - Phone:407-384-1053
Mailing Address - Fax:407-277-8168
Practice Address - Street 1:12780 WATERFORD LAKES PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4501
Practice Address - Country:US
Practice Address - Phone:407-384-1053
Practice Address - Fax:407-277-8168
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013465-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical