Healthcare Provider Details

I. General information

NPI: 1427794155
Provider Name (Legal Business Name): SHYLET MUKASA DO., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 04/16/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E WOODLAND AVE STE 200
SPRINGFIELD PA
19064-3956
US

IV. Provider business mailing address

502 CURTIS CT
CHESTERBROOK PA
19087-1240
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-4471
  • Fax:
Mailing address:
  • Phone: 972-251-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS024273
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT021509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: