Sanjay K Shukla, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

039940 Issued in GA

Practice address

3130 Mathis Airport Pkwy
Ste. 305
Suwanee, GA 30024-9131

Phone

(770) 886-7711

Fax

(770) 886-7698

NPI assigned

Feb 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: sshukla20165@direct.emory.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gwinnett Clinic LTD

  • Multi-Specialty Clinic/Center
  • Duluth, GA
  • NPI 1629117650
  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1942272935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 769609",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300768224",
            "telephone_number": "770-886-7711",
            "fax_number": "770-886-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 MATHIS AIRPORT PKWY",
            "address_2": "STE. 305",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300249131",
            "telephone_number": "770-886-7711",
            "fax_number": "770-886-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUKLA",
        "first_name": "SANJAY",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "039940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shree Lakshmi Vishnu LLC
• Maria Shrewsbury, MS, CCC-SLP
• Nicholas A Shrewsbury, BCBA
• Shubham 7 LLC
• Austin Shugart
• Christine Dougherty Shurley, D.D.S.
• Mary Siatkowski, OTR,L
• Ryan Jon Siegmund, D.C.
• Silver Health Services, Inc
• Kevin Simmons

• Family Medicine Physician in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.