Provider Demographics
NPI:1124228747
Name:WAGLE SHUKLA, APARNA ASHUTOSH (MD)
Entity Type:Individual
Prefix:
First Name:APARNA
Middle Name:ASHUTOSH
Last Name:WAGLE 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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-8408
Mailing Address - Fax:352-265-8409
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-8408
Practice Address - Fax:352-265-8409
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-66482084N0400X
FLME1081922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184915001Medicaid
FL003164700Medicaid
FL003164700Medicaid
FLEP719ZMedicare PIN