MEDICARE: MEENAL 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	207R00000X	Internal Medicine Physician	236773	NY

General Provider Information

NPI Number	:	1508806076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEENAL SHUKLA M.D.

Provider Business Mailing Address
First Line	:	14 KRISTI DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-1309
Country	:	US
Telephone Number	:	516-708-7008
Fax Number	:	347-464-0850

Provider Business Practice Location Address
First Line	:	1530 BEDFORD AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4117
Country	:	US
Telephone Number	:	718-400-6951
Fax Number	:	347-789-9300

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/16/2022

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