Provider Demographics
NPI:1659329803
Name:NOUKLA, SHAHERA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHERA
Middle Name:A
Last Name:NOUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 SWEET HOME RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1018
Mailing Address - Country:US
Mailing Address - Phone:716-689-0040
Mailing Address - Fax:716-568-2330
Practice Address - Street 1:1185 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1018
Practice Address - Country:US
Practice Address - Phone:716-689-0040
Practice Address - Fax:716-568-2330
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226625-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527123001OtherHEALTH NOW
NY161000580OtherNOVA
NY161000580OtherAETNA
NY161000580OtherEMPIRE
NY02375024Medicaid
NY00026166301OtherUNIVERA
NY0411557OtherIHA
NY161000580OtherNORTH AMERICAN PREFERRED
NY0411557OtherIHA
NY161000580OtherNORTH AMERICAN PREFERRED