Provider Demographics
NPI:1629378583
Name:MAHAJAN, NEELU (PA - C)
Entity type:Individual
Prefix:
First Name:NEELU
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:NEELU
Other - Middle Name:
Other - Last Name:NEEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11500 STATE HIGHWAY 121 STE 910
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9347
Mailing Address - Country:US
Mailing Address - Phone:469-200-2605
Mailing Address - Fax:469-200-2606
Practice Address - Street 1:11500 STATE HIGHWAY 121 STE 910
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9347
Practice Address - Country:US
Practice Address - Phone:469-200-2605
Practice Address - Fax:469-200-2606
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373530YKQLMedicare PIN