Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 002030 | NY |
Y | 2080P0214X | Pediatric Pulmonologist | 002030 | NY |
NPI | 1356403042 |
---|---|
Provider Name | Mayank Shukla |
First Address | New York, NY 10016-3256 |
Second Address | New York, NY 10016-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2006 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02514730 | (05) | NY |