Provider Demographics
NPI:1447307921
Name:SHUKLA, AMEET TARUNKUMAR (PA-C)
Entity type:Individual
Prefix:MR
First Name:AMEET
Middle Name:TARUNKUMAR
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:14973 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3878
Practice Address - Country:US
Practice Address - Phone:623-815-2900
Practice Address - Fax:523-583-1319
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2898363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical