Provider Demographics
NPI:1306643242
Name:SHUKLA, KINJALBEN MOUNESH
Entity type:Individual
Prefix:
First Name:KINJALBEN
Middle Name:MOUNESH
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RALEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:732-357-6437
Mailing Address - Fax:
Practice Address - Street 1:12 RALEIGH WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1700
Practice Address - Country:US
Practice Address - Phone:732-357-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15284400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health