SHANNON P KUKULKA (NPI# 1982072591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982072591 |
| Entity Type | Individual |
| Full Name | SHANNON P KUKULKA |
| Credential | APRN |
| Practice Address |
874 Howard Ave New Haven CT 06519-1106 |
| Practice Telephone | 2036888200 |
| Practice Fax Number | 2036888200 |
| Mailing Telephone | 2036888200 |
| Mailing Fax Number | 2036888200 |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2018-01-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
6878 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | UNITED HEALTHCARE | 1982072591 | 01 |
| CT | MULTIPLAN | 1982072591 | 01 |
| CT | AETNA | 4869372 | 01 |
| CT | ANTHEM | 1982072591 | 01 |
| CT | 1982072591 | 05 | |
| CT | HARVARD PILGRIM | AA533003 | 01 |
| CT | CIGNA | 6028631 | 01 |
| CT | OXFORD | P5602305 | 01 |
| Street Address |
874 HOWARD AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06519-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457352437 | Dermot M Mcdermott | Physician Assistant | 874 Howard Ave, New Haven, CT 06519-1106 | 2005-08-02 |
| 1730667270 | Michael Riley Levien | Nurse Practitioner | 874 Howard Ave, New Haven, CT 06519-1106 | 2018-08-06 |
| 1922463835 | Thao T Nguyen | Nurse Practitioner | 874 Howard Ave, Basement - Room 007, New Haven, CT 06519-1106 | 2015-12-18 |
| 1053679431 | Alessandra Capobianco | Internal Medicine | 874 Howard Ave, Nemg - Ynh Geriatric Services, New Haven, CT 06519-1106 | 2012-04-24 |
| 1851666085 | Gregory Michael Ouellet | Internal Medicine | 874 Howard Ave, New Haven, CT 06519 | 2012-03-21 |
| 1598080384 | Hsiao-ying Chin | Internal Medicine | 874 Howard Ave, Basement - Room 007, New Haven, CT 06519-1106 | 2010-04-05 |
| 1891019675 | Mill Hill Medical Consultants Inc | Internal Medicine | 874 Howard Ave, New Haven, CT 06519-1106 | 2010-03-23 |
| 1043544596 | Susann Varano I | Internal Medicine | 874 Howard Ave, Basement, Room 007, New Haven, CT 06519-1106 | 2009-09-30 |
| 1164658233 | Marcia Cathleen Mecca | Internal Medicine | 874 Howard Ave, New Haven, CT 06519-1106 | 2009-06-03 |
| 1972740124 | Ronald L. Miller | Internal Medicine | 874 Howard Ave, New Haven, CT 06519-1106 | 2009-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255819348 | Jordan Ficocelli | Nurse Practitioner | 800 Howard Ave # 2, New Haven, CT 06519 | 2018-08-01 |
| 1780123414 | Claire Louise Hardin | General Acute Care Hospital | 95 Howard Ave, New Haven, CT 06519 | 2017-02-14 |
| 1467809137 | Ana Laura Vives-rodriguez | Student in an Organized Health Care Education/Training Program | 800 Howard Avenue, Lower Level, Yale Physicians Building, New Haven, CT 06519 | 2016-05-23 |
| 1346607785 | Amanda Kayte Corcoran | Advanced Practice Midwife | 40 Prince St., Suite 207, New Haven, CT 06519 | 2016-01-15 |
| 1720491905 | Sara Harcharik Perkins | Dermatology | 2 Church St S Ste 305, New Haven, CT 06519 | 2014-06-05 |
| 1194136713 | Krishan Ratilal Jethwa | Radiology | 35 Park St Ste Ll507, New Haven, CT 06519 | 2014-05-16 |
| 1235549353 | Brandon Michael Kitay | Psychiatry & Neurology | 184 Liberty St # Lv108, New Haven, CT 06519 | 2014-04-28 |
| 1649526617 | Yale New Haven Hospital | Student in an Organized Health Care Education/Training Program | 330 Cedar St Fmb 107, Yale New Haven Hospital, Dept of Surgery, New Haven, CT 06519 | 2012-07-27 |
| 1669736765 | Mayanka Tickoo | Internal Medicine | 300 Cedar St Fl 4, New Haven, CT 06519 | 2012-07-03 |
| 1730441627 | Judith A Ross | Physical Therapist | 18 Tower Lane, Tower One Tower East, New Haven, CT 06519 | 2012-06-15 |
| Find all providers in zip 06519 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306409222 | Terance A Anderson | Nurse Practitioner | 20 York Street, Cb-2041, New Haven, CT 06510-3220 | 2019-04-16 |
| 1730667270 | Michael Riley Levien | Nurse Practitioner | 874 Howard Ave, New Haven, CT 06519-1106 | 2018-08-06 |
| 1972098762 | Hung Le | Nurse Practitioner | 20 York Street, Cb-2041, New Haven, CT 06510 | 2018-06-25 |
| 1295286110 | Qian Zeng | Nurse Practitioner | 20 York St, New Haven, CT 06510-3220 | 2016-10-14 |
| 1922463835 | Thao T Nguyen | Nurse Practitioner | 874 Howard Ave, Basement - Room 007, New Haven, CT 06519-1106 | 2015-12-18 |
| 1669853800 | Jamie Stone Feingold | Nurse Practitioner | 20 York St, New Haven, CT 06510-3220 | 2015-06-13 |
| 1134535859 | Rachel M Pisani | Nurse Practitioner | 20 York St, New Haven, CT 06510-3220 | 2014-07-02 |
| 1023223633 | Innovative Health Concepts | Nurse Practitioner | 1201 Daly Dr, New Haven, IN 46774-1891 | 2007-05-14 |
| 1962471342 | Zina I Crescenzi | Nurse Practitioner | 1450 Chapel Street, New Haven, CT 06511 | 2006-03-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255956421 | Thomas Lorbie Thomson IIi | Nurse Practitioner | Va Connecticut Healthcare, 950 Campbell Avenue, Mail Code: 11acsl1, Building 2b, West Haven, CT 06516 | 2020-06-12 |
| 1427689660 | Sajini M Roy | Nurse Practitioner | 172 Guinea Rd, Monroe, CT 06468-1044 | 2020-01-27 |
| 1073171393 | Sabine Donato Dabady | Nurse Practitioner | 287 Capitol Ave, Waterbury, CT 06705-2407 | 2019-06-01 |
| 1720599541 | Sherifa Bello | Nurse Practitioner | 1333 Burnside Ave Apt A3, East Hartford, CT 06108-1517 | 2017-10-19 |
| 1750808994 | Ronald S. Perpetua | Nurse Practitioner | 107 Bassett Rd, North Haven, CT 06473-1902 | 2017-08-28 |
| 1891247805 | Campbell Medical Care, LLC | Nurse Practitioner | 22 Parkwood Dr, Windsor, CT 06095-3142 | 2016-10-26 |
| 1861745259 | Marguerite Kalowsky Benoit | Nurse Practitioner | 187 Bouton St W, Stamford, CT 06907-1320 | 2012-10-22 |
| 1396977997 | Debra Innes Coyle | Nurse Practitioner | 85 Huckleberry Ln, Southington, CT 06489-4319 | 2009-08-14 |
| 1487727228 | Leeanne E Shaw-quinn | Nurse Practitioner | 30 Hyde Ave Ste 109, Vernon, CT 06066-4503 | 2006-11-17 |
| 1184648925 | Karen S Williams | Nurse Practitioner | 25 Witch Meadow Rd, Salem, CT 06420-3602 | 2006-07-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.