Individual
SHAWN SANJEEV SHUKLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 585-1620
Mailing address
4953 S HAWTHORNE CT, NEW BERLIN, WI 53151-7662
(414) 213-1724
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
73151-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2016
Last updated
07/29/2020
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