Provider Demographics
NPI:1689802787
Name:SHAKYA, KUNJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNJAN
Middle Name:
Last Name:SHAKYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1649
Mailing Address - Country:US
Mailing Address - Phone:919-848-2229
Mailing Address - Fax:919-848-8238
Practice Address - Street 1:7205 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1649
Practice Address - Country:US
Practice Address - Phone:919-848-2229
Practice Address - Fax:919-848-8238
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics