Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 9731 | MA |
NPI | 1134301385 |
---|---|
Provider Name | Dr. Priyanka Shukla |
First Address | Mattapan, MA 02126-2253 |
Second Address | Mattapan, MA 02126-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 29/11/2007 |