Provider Demographics
NPI:1396787743
Name:SHUKLA, MELISSA S (DPM)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1535
Mailing Address - Country:US
Mailing Address - Phone:610-838-6808
Mailing Address - Fax:610-838-5333
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1535
Practice Address - Country:US
Practice Address - Phone:610-838-6808
Practice Address - Fax:610-838-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005634213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100832172002Medicaid
PAU80532Medicare UPIN
PA100832172002Medicaid