Healthcare Provider Details

I. General information

NPI: 1285643403
Provider Name (Legal Business Name): SHAILENDRA K SAXENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S 144TH ST STE 220
OMAHA NE
68144-5249
US

IV. Provider business mailing address

2727 S 144TH ST STE 220
OMAHA NE
68144-5249
US

V. Phone/Fax

Practice location:
  • Phone: 402-778-5500
  • Fax: 402-778-5639
Mailing address:
  • Phone: 402-778-5500
  • Fax: 402-778-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20848
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: