Healthcare Provider Details

I. General information

NPI: 1831279504
Provider Name (Legal Business Name): NEELA JAYESH SHUKLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 STORE HOUSE LN SUITE B
DESTREHAN LA
70047
US

IV. Provider business mailing address

31 CYCAS
KENNER LA
70065-6188
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-6556
  • Fax: 985-764-6526
Mailing address:
  • Phone: 504-469-4867
  • Fax: 504-469-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number05778R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: