Provider Demographics
NPI:1336708411
Name:PRASAD, SHALESHWAR (BS)
Entity type:Individual
Prefix:
First Name:SHALESHWAR
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 ROSIN CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1646
Mailing Address - Country:US
Mailing Address - Phone:916-441-0226
Mailing Address - Fax:
Practice Address - Street 1:3780 ROSIN CT STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1698
Practice Address - Country:US
Practice Address - Phone:916-441-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN738401164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB6467729Medicaid