Healthcare Provider Details

I. General information

NPI: 1720914385
Provider Name (Legal Business Name): HARDI SHUKLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 US HIGHWAY 19
HOLIDAY FL
34691-1846
US

IV. Provider business mailing address

600 TECHNOLOGY PARK STE 101
LAKE MARY FL
32746-7122
US

V. Phone/Fax

Practice location:
  • Phone: 727-359-0371
  • Fax: 727-359-0374
Mailing address:
  • Phone: 407-543-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: