Provider Demographics
NPI:1245877315
Name:ACHARYA, SHAILENDRA (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHAILENDRA
Middle Name:
Last Name:ACHARYA
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 HAVEN PL APT 112
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7920
Mailing Address - Country:US
Mailing Address - Phone:925-336-9739
Mailing Address - Fax:
Practice Address - Street 1:5010 HAVEN PL APT 112
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7920
Practice Address - Country:US
Practice Address - Phone:925-336-9739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-07
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily