Shannon P Kukulka, APRN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

6878 Issued in CT

Practice address

874 Howard Ave
New Haven, CT 06519-1106

Phone

(203) 688-8200

Fax

(203) 688-8200

NPI assigned

Sep 14, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Geriatric and Adult Psychiatry, LLC

  • Mental Health Counselor
  • Hamden, CT
  • NPI 1770791493
  Medicare reassignment NPD
• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment NPD
• Geriatric and Adult Psychiatry, LLC

  • Mental Health Counselor
  • Hamden, CT
  • NPI 1942470018
  NPD (past)

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514937600000",
    "number": "1982072591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "874 HOWARD AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191106",
            "telephone_number": "203-688-8200",
            "fax_number": "203-688-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 HOWARD AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191106",
            "telephone_number": "203-688-8200",
            "fax_number": "203-688-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKULKA",
        "first_name": "SHANNON",
        "middle_name": "P",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-14",
        "last_updated": "2018-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CT",
            "license": "6878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1982072591",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "1982072591",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4869372",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "1982072591",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982072591",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA533003",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P5602305",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6028631",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Kuerze
• Aisha Kuforiji
• Angelea Kuipers
• Shqiponja Kuka, PA
• Jatin Kukreja
• Kyle David Kulas
• Kaustubh Rajesh Kulkarni, MD, PHD
• Sanjay Kulkarni, MD
• Michal E. Kulon, M.D.
• Abhishek Kumar, M.D.

• Gerontology Nurse Practitioner in New Haven, CT
• Providers in New Haven, CT by specialty
• Gerontology Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; 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.