Provider Demographics
NPI:1508054248
Name:SHUKLA, ANITA NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:NATHAN
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:NATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:97 LIBBEY INDUSTRIAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3110
Mailing Address - Country:US
Mailing Address - Phone:781-331-3300
Mailing Address - Fax:781-331-8356
Practice Address - Street 1:97 LIBBEY INDUSTRIAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EAST WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3110
Practice Address - Country:US
Practice Address - Phone:781-331-3300
Practice Address - Fax:781-331-8356
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246913207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002225402OtherMEDICARE
MA110089196AMedicaid
MA764488OtherTUFTS ASSOCIATED HEALTH PLAN
MAAA315305OtherHARVARD PILGRIM