Provider Demographics
NPI:1588981518
Name:SHUKLA, ANSHU (MD, MS)
Entity type:Individual
Prefix:DR
First Name:ANSHU
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 KENNEDY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2668
Mailing Address - Country:US
Mailing Address - Phone:513-281-3400
Mailing Address - Fax:
Practice Address - Street 1:5400 KENNEDY AVE STE 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2668
Practice Address - Country:US
Practice Address - Phone:513-281-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012599682085N0700X
GUM-21542085R0202X
OH35.1333602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology