Basic Information
Provider Information
NPI: 1841869013
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHRESTHA
FirstName: PALLABI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1501 N CAMPBELL AVE RM 6336
Address2:  
City: TUCSON
State: AZ
PostalCode: 857240001
CountryCode: US
TelephoneNumber: 5206262760
FaxNumber: 5206266020
Practice Location
Address1: 2800 E AJO WAY
Address2:  
City: TUCSON
State: AZ
PostalCode: 857136204
CountryCode: US
TelephoneNumber: 5206261728
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2021
LastUpdateDate: 04/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XR78637AZY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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