Provider Demographics
NPI:1942276639
Name:SHUKLA, HARI KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARI KRISHNA
Middle Name:
Last Name:SHUKLA
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 1:42-72 KISSENA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-961-4000
Mailing Address - Fax:718-359-6677
Practice Address - Street 1:42-72 KISSENA BOULEVARD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-961-4000
Practice Address - Fax:718-445-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1570372080N0001X
NY32137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00895923Medicaid
NY00895923Medicaid