Provider Demographics
NPI:1336515063
Name:SHUKLA, LINDSEY M (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:RAE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-C
Mailing Address - Street 1:28 CENTRE DR
Mailing Address - Street 2:UVM MEDICAL CENTER - MILTON FAMILY MEDICINE
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3104
Mailing Address - Country:US
Mailing Address - Phone:802-847-4322
Mailing Address - Fax:802-847-1570
Practice Address - Street 1:28 CENTRE DR
Practice Address - Street 2:UVM MEDICAL CENTER - MILTON FAMILY MEDICINE
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3104
Practice Address - Country:US
Practice Address - Phone:802-847-4322
Practice Address - Fax:802-847-1570
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209964363LF0000X
VT101.0124800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175453AMedicaid
GA20250I8632Medicare PIN