Healthcare Provider Details

I. General information

NPI: 1306428263
Provider Name (Legal Business Name): HIRAL SHUKLA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVENUE, 1ST FLOOR
MOUNT HOLLY NJ
08060
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6000
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB12411300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: