Healthcare Provider Details

I. General information

NPI: 1427972835
Provider Name (Legal Business Name): ABHAY ANAND SHUKLA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EARHART DR
BUFFALO NY
14221-7078
US

IV. Provider business mailing address

48 PEPPERTREE DR
BUFFALO NY
14228-2901
US

V. Phone/Fax

Practice location:
  • Phone: 716-691-0091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number20224187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: