Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 14459 | NV |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 14459 | NV |
NPI | 1134266497 |
---|---|
Provider Name | Sanjai Shukla |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134266497 | (05) | NV |
12410374 | CAQH (01) |