Provider Demographics
NPI:1003862228
Name:SHUKLA, SONALI (MD)
Entity Type:Individual
Prefix:
First Name:SONALI
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 LINCOLNWAY
Mailing Address - Street 2:POST OFFICE BOX 1539
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3201
Mailing Address - Country:US
Mailing Address - Phone:219-326-2403
Mailing Address - Fax:219-326-2385
Practice Address - Street 1:1007 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3201
Practice Address - Country:US
Practice Address - Phone:219-326-2403
Practice Address - Fax:219-326-2385
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060482A207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN910640FFFMedicare ID - Type Unspecified
INI44141Medicare UPIN