Healthcare Provider Details

I. General information

NPI: 1396787743
Provider Name (Legal Business Name): MELISSA S SHUKLA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 GERYVILLE PIKE STE 201
PENNSBURG PA
18073-2306
US

IV. Provider business mailing address

2793 GERYVILLE PIKE STE 201
PENNSBURG PA
18073-2306
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5221
  • Fax:
Mailing address:
  • Phone: 484-822-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005634
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: