Provider Demographics
NPI:1255025771
Name:SHAH, KRUNAL (FNP-C)
Entity type:Individual
Prefix:
First Name:KRUNAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 KELLY PASS
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-5572
Mailing Address - Country:US
Mailing Address - Phone:551-358-6878
Mailing Address - Fax:
Practice Address - Street 1:ESKENAZI HEALTH CENTER GRASSY CREEK 9443 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2132
Practice Address - Country:US
Practice Address - Phone:317-890-2100
Practice Address - Fax:317-890-2171
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013975A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily