Kishorkumar N Shukla, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME0076361 Issued in FL

Practice address

2501 S Volusia Ave Ste 100
Unit a
Orange City, FL 32763-9134

Phone

(386) 789-9000

Fax

(386) 775-9700

NPI assigned

Jul 28, 2006

Last updated

Mar 22, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1003820762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 S VOLUSIA AVE STE 100",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639134",
            "telephone_number": "386-789-9000",
            "fax_number": "386-775-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 S VOLUSIA AVE STE 100",
            "address_2": "UNIT A",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639134",
            "telephone_number": "386-789-9000",
            "fax_number": "386-775-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUKLA",
        "first_name": "KISHORKUMAR",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0076361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255838600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dany Shamoun, M.D.
• Neeraj Sharma, MD
• Olivia Shenkle
• Kelly Sherwin
• Natalia Deepak Shringarpure, MD
• Jessica K Shutt, RNCS
• Sarah Sidhom, DMD
• Marlene Silver, RN
• Janiyah Simmons
• Simonmed Imaging Florida LLC (Simonmed Imaging Orange City)

• Pediatrics Physician in Orange City, FL
• Providers in Orange City, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.