Shagun Ganesh Agrawal, DO
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Kingman, AZ
NPI 1104750215 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1104750215
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- R4962 (AZ)
- Practice address
- 3269 N Stockton Hill Rd
Kingman, AZ 86409-3619 - Phone
- (928) 263-3160
- NPI assigned
- Jun 12, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | R4962 | AZ | Yes |
Addresses
Primary practice location
3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Mailing address
3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (928) 263-3160
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- Suleman S Ahmed
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- Anthonia Ajao
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All providers in Kingman, AZ · Student in an Organized Health Care Education/Training Program in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.