Healthcare Provider Details

I. General information

NPI: 1205763018
Provider Name (Legal Business Name): CALEY BRYCE SHUKALEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TALMADGE TD UNITE #312
EDISON NJ
08817
US

IV. Provider business mailing address

700 2 ST SW 3200 (PURPOSE MED)
CALGARY ALBERTA
T2P 4W3
CA

V. Phone/Fax

Practice location:
  • Phone: 437-747-7584
  • Fax: 855-719-0483
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV9717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: