Provider Demographics
NPI:1508943861
Name:SHUKLA, NAGULINIE (PNP)
Entity type:Individual
Prefix:MRS
First Name:NAGULINIE
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1023
Mailing Address - Country:US
Mailing Address - Phone:315-446-4580
Mailing Address - Fax:315-446-3426
Practice Address - Street 1:6851 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1023
Practice Address - Country:US
Practice Address - Phone:315-446-4580
Practice Address - Fax:315-446-3426
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381192363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics