Provider Demographics
NPI:1184895468
Name:SHUKLA, ANAMIKA (PA)
Entity type:Individual
Prefix:MRS
First Name:ANAMIKA
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20160
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0160
Mailing Address - Country:US
Mailing Address - Phone:661-664-0600
Mailing Address - Fax:661-664-0621
Practice Address - Street 1:9900 STOCKDALE HWY STE 107
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3633
Practice Address - Country:US
Practice Address - Phone:661-664-0600
Practice Address - Fax:661-664-0621
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-C16816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA168160OtherLICENSE