Provider Demographics
NPI:1285627703
Name:SHUKLA, HIMANSHU HARSHADRAY (MD)
Entity type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:HARSHADRAY
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14285 N US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:CITRA
Mailing Address - State:FL
Mailing Address - Zip Code:32113-3643
Mailing Address - Country:US
Mailing Address - Phone:602-751-2358
Mailing Address - Fax:
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6505
Practice Address - Country:US
Practice Address - Phone:352-629-1378
Practice Address - Fax:352-629-1406
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME169723207RC0001X
AZ33766207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ941056Medicaid
AZZ113435OtherMEDICARE PTAN
FL124536200Medicaid
AZ941056Medicaid