Healthcare Provider Details

I. General information

NPI: 1124513270
Provider Name (Legal Business Name): SHANILA SHAGUFTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12850 DALLAS PKWY STE 200
FRISCO TX
75033-0844
US

IV. Provider business mailing address

1604 HOSPITAL PKWY STE 407
BEDFORD TX
76022-6932
US

V. Phone/Fax

Practice location:
  • Phone: 469-678-7802
  • Fax: 833-972-5253
Mailing address:
  • Phone: 972-573-3855
  • Fax: 833-973-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberU5517
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: