Basic Information
| Provider Information | |||||||||
| NPI: | 1497168926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHRESTHA | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | C.S.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2984 KINCAID DR | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206035784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403837035 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 RESERVOIR RD NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200072113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024447095 | ||||||||
| FaxNumber: | 2024447856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2014 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | SA0134 | DC | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.