Healthcare Provider Details

I. General information

NPI: 1811523897
Provider Name (Legal Business Name): SHAILAVI JAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11330 LEGACY DR STE 205
FRISCO TX
75033-1218
US

IV. Provider business mailing address

950 E STATE HIGHWAY 114 STE 200
SOUTHLAKE TX
76092-5261
US

V. Phone/Fax

Practice location:
  • Phone: 469-535-5070
  • Fax: 214-436-4798
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberU3551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: