Healthcare Provider Details

I. General information

NPI: 1356490437
Provider Name (Legal Business Name): EVELYN M SHUKAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN MONROE

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

670 W END AVE
NEW YORK NY
10025-7313
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5000
  • Fax: 718-579-5689
Mailing address:
  • Phone: 718-570-5000
  • Fax: 719-579-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number137015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: