Provider Demographics
NPI:1508806076
Name:SHUKLA, MEENAL (MD)
Entity Type:Individual
Prefix:
First Name:MEENAL
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 KRISTI DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1309
Mailing Address - Country:US
Mailing Address - Phone:516-708-7008
Mailing Address - Fax:347-464-0850
Practice Address - Street 1:1530 BEDFORD AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4117
Practice Address - Country:US
Practice Address - Phone:718-400-6951
Practice Address - Fax:347-789-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY236773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI41197Medicare UPIN
NY150SG1Medicare PIN