Provider Demographics
NPI:1932369964
Name:SEGAN, SHIVANI PJ (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:PJ
Last Name:SEGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:P
Other - Last Name:JAYASWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3023 S UNIVERSITY DRIVE
Mailing Address - Street 2:STE 135
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:682-582-7001
Mailing Address - Fax:682-224-8932
Practice Address - Street 1:3023 S UNIVERSITY DRIVE
Practice Address - Street 2:STE 135
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:682-582-7001
Practice Address - Fax:682-224-8932
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205217207L00000X
KYTP398207L00000X
390200000X
TXQ2618207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106542Medicaid
MS01751762Medicaid
MS01751762Medicaid