Provider Demographics
NPI:1427794155
Name:MUKASA, SHYLET (DO, PHD)
Entity type:Individual
Prefix:
First Name:SHYLET
Middle Name:
Last Name:MUKASA
Suffix:
Gender:
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CURTIS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1240
Mailing Address - Country:US
Mailing Address - Phone:972-251-9395
Mailing Address - Fax:
Practice Address - Street 1:1260 E WOODLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3956
Practice Address - Country:US
Practice Address - Phone:610-690-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS024273207Q00000X
PAOT021509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine