| Doctor Name: | MRS. JETAL SHUKLA |
| NPI Number: | 1467854224 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 5007179 |
| Business Practice Address: | 2600 Nc Highway 97 Wendell, NC - 275919319 |
| Business Phone Number: | 9193657272 |
| Business Fax Number: | 9193657215 |
| Mailing Address: | Po Box 2170, 2600 Nc Hwy 97 WENDELL |
| State: | NC |
| Postal Code: | 275912170 |
| Phone Number: | 9193657272 |
| Fax Number: | 9193657215 |
| NPI Enumeration Date: | 09/23/2014 |
| NPI Last Update Date: | 03/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5007179 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |