Provider Demographics
NPI:1558479139
Name:SHRESTHA, VINU (MD)
Entity type:Individual
Prefix:
First Name:VINU
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VINU
Other - Middle Name:
Other - Last Name:DALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:970-490-4175
Practice Address - Street 1:8890 N UNION BLVD
Practice Address - Street 2:STE 170
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7799
Practice Address - Country:US
Practice Address - Phone:719-572-5005
Practice Address - Fax:719-572-5551
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74478206Medicaid
CO316253YLB8Medicare PIN