Healthcare Provider Details

I. General information

NPI: 1922451384
Provider Name (Legal Business Name): DR. APURWA SHUKLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BEVILLE RD
DAYTONA BEACH FL
32114-5646
US

IV. Provider business mailing address

1500 BEVILLE RD
DAYTONA BEACH FL
32114-5646
US

V. Phone/Fax

Practice location:
  • Phone: 386-253-6634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 22074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: