Provider Demographics
NPI:1205130028
Name:SHUKLA, HEMANGI PRABODH (DO)
Entity type:Individual
Prefix:
First Name:HEMANGI
Middle Name:PRABODH
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 135TH ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2821
Mailing Address - Country:US
Mailing Address - Phone:178-206-6808
Mailing Address - Fax:718-206-6829
Practice Address - Street 1:8906 135TH ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2821
Practice Address - Country:US
Practice Address - Phone:178-206-6808
Practice Address - Fax:718-206-6829
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259370207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology