Provider Demographics
NPI:1922189877
Name:SHUKLA, NILIMA VIKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NILIMA
Middle Name:VIKRAM
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NILIMA
Other - Middle Name:DAFTARY
Other - Last Name:SHUKLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1530 UNION RD STE A
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2201
Mailing Address - Country:US
Mailing Address - Phone:704-867-6188
Mailing Address - Fax:704-866-4437
Practice Address - Street 1:1530 UNION RD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2201
Practice Address - Country:US
Practice Address - Phone:704-867-6188
Practice Address - Fax:704-866-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33303174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1088LOtherBCBS
NC891088LMedicaid
NC213170EMedicare PIN
NCC65097Medicare UPIN