Healthcare Provider Details

I. General information

NPI: 1285627703
Provider Name (Legal Business Name): HIMANSHU HARSHADRAY SHUKLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E CHANDLER BLVD BLDG 2
CHANDLER AZ
85225-0010
US

IV. Provider business mailing address

14285 N US HIGHWAY 441
CITRA FL
32113-3643
US

V. Phone/Fax

Practice location:
  • Phone: 602-532-1000
  • Fax:
Mailing address:
  • Phone: 602-751-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME169723
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33766
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: