Provider Demographics
NPI:1225470396
Name:MATHUR, SHAGUNA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAGUNA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:531-355-7420
Mailing Address - Fax:531-355-6921
Practice Address - Street 1:555 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2136
Practice Address - Country:US
Practice Address - Phone:531-355-7420
Practice Address - Fax:531-355-6921
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2685762084N0400X
IL125064197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics