Provider Demographics
NPI:1801981386
Name:SHUKLA, NIMISHA J (MD)
Entity type:Individual
Prefix:DR
First Name:NIMISHA
Middle Name:J
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802, OAK TREE RD.
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2704
Mailing Address - Country:US
Mailing Address - Phone:732-548-3210
Mailing Address - Fax:732-906-3966
Practice Address - Street 1:1802, OAK TREE RD.
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2704
Practice Address - Country:US
Practice Address - Phone:732-548-3210
Practice Address - Fax:732-906-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06753200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1504986OtherGHI
NJ2633060OtherAETNA
NJ0B1261OtherEMPIRE
NJP1637450OtherOXFORD PROVIDER ID#
NJJ9447OtherHORIZON
NJJ9447OtherHORIZON