Healthcare Provider Details

I. General information

NPI: 1780089946
Provider Name (Legal Business Name): SHRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BRYANT AVE STE 101
EDMOND OK
73034-6330
US

IV. Provider business mailing address

15601 KESTRAL PARK CT
EDMOND OK
73013-9505
US

V. Phone/Fax

Practice location:
  • Phone: 405-622-3063
  • Fax: 405-732-0022
Mailing address:
  • Phone: 405-642-8613
  • Fax: 405-732-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27981
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number27981
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number27981
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number27981
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27981
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number27981
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number27981
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number27981
License Number StateOK
# 9
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number27981
License Number StateOK
# 11
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number27981
License Number StateOK
# 12
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number27981
License Number StateOK
# 13
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27981
License Number StateOK

VIII. Authorized Official

Name: RAKESH SHRIVASTAVA
Title or Position: OWNER
Credential: MD
Phone: 405-642-8613