Provider Demographics
NPI:1588861751
Name:SHUKLA, SHWETANSHU M (MD)
Entity type:Individual
Prefix:
First Name:SHWETANSHU
Middle Name:M
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 N LAKEMONT AVE STE 2300
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3208
Mailing Address - Country:US
Mailing Address - Phone:321-444-6560
Mailing Address - Fax:407-960-1902
Practice Address - Street 1:201 N LAKEMONT AVE STE 2300
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3208
Practice Address - Country:US
Practice Address - Phone:321-444-6560
Practice Address - Fax:407-960-1902
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187880207R00000X
FLME104988208M00000X
CAC56215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine