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General NPI Number Information
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NPI Number | 1831299783
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Entity Type | Individual
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Provider Name | PADMA KANT SHUKLA MD FACP FACC
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1860 TOWN CENTER DR SUITE #210
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City | RESTON
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State | VA
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Zip | 20190
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Country | US
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Telephone | 703-481-6999
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Fax | 703-437-1101
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Provider Business Mailing Address
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Address Line | 1860 TOWN CENTER DRIVE SUITE #210
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City | RESTON
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State | VA
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Zip | 20190
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Country | US
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Telephone | 703-481-6999
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Fax | 703-437-1101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101038073
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License Number State | VA
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