MEDICARE: CHITTARANJAN JAYSHANKER SHUKLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	34405	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0256	OTHER	KY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	610661458	OTHER	KY	GROUP TAX ID

General Provider Information

NPI Number	:	1083672398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHITTARANJAN JAYSHANKER SHUKLA M.D.

Provider Business Mailing Address
First Line	:	2720 AIRPORT DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2219
Country	:	US
Telephone Number	:	614-388-7650
Fax Number	:	614-473-3789

Provider Business Practice Location Address
First Line	:	2720 AIRPORT DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2219
Country	:	US
Telephone Number	:	614-388-7650
Fax Number	:	614-473-3789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	09/28/2018

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Directions to “ CHITTARANJAN JAYSHANKER SHUKLA M.D.” Practice Location

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