Shailesh Manandhar, M.D.
Individual provider Active NPI Pediatrics Physician · Elon, NC
NPI 1679005409 · NPPES record last updated Nov 8, 2022
Key facts
- NPI
- 1679005409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 2020-03574 (NC)
- Practice address
- 812 W Haggard Ave
Elon, NC 27244-9134 - Phone
- (336) 449-4030
- Fax
- (336) 449-5315
- NPI assigned
- Mar 30, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201216002770 | NC | Practitioner - Pediatric Medicine | 9537571468 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020-03574 | NC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amm Healthcare, PA | Pediatrics | Current |
Accepting new patients |
| Jacksonville Children'S and Multispecialty Clinic, PA | Pediatrics | Current |
Accepting new patients |
| Jacksonville Behavior and Mental Health | Current |
Accepting new patients | |
| Family Care Clinic, P.a. | Past | Accepting new patients | |
| American Healthcare Systems, LLC | Pediatrics | Past | Accepting new patients |
Locations
124 Towerview Ct
Cary, NC 27513
812 W Haggard Ave
Elon College, NC 27244
Phone (336) 449-4030
118 Memorial Dr
Jacksonville, NC 28546
Phone (910) 353-0581
120 Memorial Dr
Jacksonville, NC 28546
Phone (910) 353-0581
114C Memorial Dr
Jacksonville, NC 28546
Phone (910) 346-3976
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2020-03574 | NC | Yes |
Addresses
Primary practice location
812 W Haggard Ave
Elon, NC 27244-9134
Mailing address
PO Box 986513
Boston, MA 02298-6513
Phone (910) 219-8310
Other practice location 1
120 Memorial Dr
Jacksonville, NC 28546-6328
Phone (910) 353-0581
Other practice location 2
118 Memorial Dr
Jacksonville, NC 28546-6328
Phone (910) 353-0581
Other providers in Elon, NC
- Maya Leemaster
- Eric Jensen Lengas
- George R Lentz Sr.
- Joseph Victor Libera
- Andrew J Lukjanczuk
- Maria McCain
- Jodi McConnell
- Michael Richard McCormack
- Carolyn Westbrook McLamb
- Heather Williams McMahon
All providers in Elon, NC · Pediatrics Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.