Provider Demographics
NPI:1902869837
Name:SHRESTHA, ANIL PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:PRASAD
Last Name:SHRESTHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:915 W MONROE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1177
Mailing Address - Country:US
Mailing Address - Phone:904-384-2240
Mailing Address - Fax:904-384-6055
Practice Address - Street 1:600 PLANTATION ISLAND DR S
Practice Address - Street 2:SUITE 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6010
Practice Address - Country:US
Practice Address - Phone:904-384-2240
Practice Address - Fax:904-429-9925
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME83286207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262490700Medicaid
FL03278OtherBCBS
FL03278VMedicare PIN
FL03278OtherBCBS