Provider Demographics
NPI:1265662852
Name:SHUKRI, MEGAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:SHUKRI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FRAZER DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2013
Mailing Address - Country:US
Mailing Address - Phone:845-721-5667
Mailing Address - Fax:
Practice Address - Street 1:27 FRAZER DR
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-2013
Practice Address - Country:US
Practice Address - Phone:845-721-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant