Healthcare Provider Details

I. General information

NPI: 1518669498
Provider Name (Legal Business Name): SHILPA KUKRETI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

IV. Provider business mailing address

1501 BLACK ROCK LN
FARMINGTON MO
63640-7774
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5096
  • Fax:
Mailing address:
  • Phone: 908-675-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10985
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: