Healthcare Provider Details

I. General information

NPI: 1871053876
Provider Name (Legal Business Name): MIHIR SHUKLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 38TH ST FL 19
NEW YORK NY
10016-2708
US

IV. Provider business mailing address

240 E 38TH ST FL 19
NEW YORK NY
10016-2708
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-4873
  • Fax:
Mailing address:
  • Phone: 713-825-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number315581
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number315581
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: