Provider Demographics
NPI:1861401291
Name:SHUKLA, MILI (OD)
Entity type:Individual
Prefix:
First Name:MILI
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 LENOX AVE # 103
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5120
Mailing Address - Country:US
Mailing Address - Phone:908-546-5681
Mailing Address - Fax:908-546-5682
Practice Address - Street 1:1290 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3518
Practice Address - Country:US
Practice Address - Phone:908-546-5681
Practice Address - Fax:908-546-5682
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00601300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0119032Medicaid
NJ0119032Medicaid