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1205763018 NPI number — CALEY BRYCE SHUKALEK MD

NPI Number: 1205763018
Health Care Provider/Practitioner: CALEY BRYCE SHUKALEK MD

Information about “1205763018” NPI (CALEY BRYCE SHUKALEK MD) exists in 1205763018 in HTML format HTML  |  1205763018 in plain Text format TXT  |  1205763018 in PDF (Portable Document Format) PDF  |  1205763018 in an XML format XML  formats.

NPI Number : 1205763018 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205763018",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHUKALEK",
    "FirstName": "CALEY",
    "MiddleName": "BRYCE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "700 2 ST SW",
    "SecondLineMailingAddress": "3200 (PURPOSE MED)",
    "MailingAddressCityName": "CALGARY",
    "MailingAddressStateName": "ALBERTA",
    "MailingAddressPostalCode": "T2P 4W3",
    "MailingAddressCountryCode": "CA",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "180 TALMADGE TD",
    "SecondLinePracticeLocationAddress": "UNITE #312",
    "PracticeLocationAddressCityName": "EDISON",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08817",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "437-747-7584",
    "PracticeLocationAddressFaxNumber": "855-719-0483",
    "EnumerationDate": "05/06/2026",
    "LastUpdateDate": "05/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "V9717",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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