Provider Demographics
NPI:1295826410
Name:SHUKLA, MINITY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MINITY
Middle Name:
Last Name:SHUKLA
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 1:1725 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2246
Mailing Address - Country:US
Mailing Address - Phone:909-319-8327
Mailing Address - Fax:
Practice Address - Street 1:1725 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2246
Practice Address - Country:US
Practice Address - Phone:909-319-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical