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General NPI Number Information
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NPI Number | 1053775189
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Entity Type | Organization
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Legal Business Name | VIKRAM R. SHUKLA, MD CHILD, ADOLESCENT & ADULT PSYCHIATRY SERVICES
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 839 MAJESTIC CT SUITE 8
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City | GASTONIA
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State | NC
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Zip | 28054-5147
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Country | US
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Telephone | 704-868-8988
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Fax | 704-868-9948
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Provider Business Mailing Address
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Address Line | 1100 VERDANT RIDGE CIR
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City | BELMONT
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State | NC
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Zip | 28012-7805
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Country | US
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Telephone | 704-868-8988
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Fax | 704-868-9948
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | VIKRAM R SHUKLA
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Credential | MD
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Telephone | 704-868-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 33304
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License Number State | NC
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