Provider Demographics
NPI:1962802967
Name:MATHEW, SHAUNA (FNP)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 LAS COLINAS BLVD W
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5421
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:214-237-1246
Practice Address - Street 1:222 LAS COLINAS BLVD W
Practice Address - Street 2:SUITE 2000
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-5421
Practice Address - Country:US
Practice Address - Phone:972-316-6495
Practice Address - Fax:972-316-6500
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP127374363LF0000X
TX781084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily