Provider Demographics
NPI:1285627703
Name:SHUKLA, HIMANSHU HARSHADRAY (MD)
Entity Type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:HARSHADRAY
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10238 E HAMPTON AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3316
Mailing Address - Country:US
Mailing Address - Phone:480-889-1573
Mailing Address - Fax:480-889-1574
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3316
Practice Address - Country:US
Practice Address - Phone:480-889-1573
Practice Address - Fax:480-889-1574
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33766207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ941056Medicaid
AZZ113435OtherMEDICARE PTAN
I28319Medicare UPIN
AZ941056Medicaid