Provider Demographics
NPI:1366726788
Name:SHUKLA, VERSHALEE (MD)
Entity type:Individual
Prefix:
First Name:VERSHALEE
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207429
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7429
Mailing Address - Country:US
Mailing Address - Phone:480-306-5390
Mailing Address - Fax:480-842-8761
Practice Address - Street 1:7469 E MONTE CRISTO AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1618
Practice Address - Country:US
Practice Address - Phone:480-306-5390
Practice Address - Fax:480-842-8761
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ451612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1342785OtherCIGNA
AZ650366Medicaid
AZ9976756OtherAETNA
AZ928961OtherWELLCARE MEDICARE ADVANTAGE
AZZ163628Medicare PIN