Provider Demographics
NPI:1639923857
Name:MATHEW, SHAUNA (CPNP-NP)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:CPNP-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BILL SHAW DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-7536
Mailing Address - Country:US
Mailing Address - Phone:469-323-0934
Mailing Address - Fax:
Practice Address - Street 1:760 N DENTON TAP RD STE 120
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2164
Practice Address - Country:US
Practice Address - Phone:972-420-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics