Healthcare Provider Details

I. General information

NPI: 1114419330
Provider Name (Legal Business Name): SHITAVIA SKANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 E RENO AVE
MIDWEST CITY OK
73110-2005
US

IV. Provider business mailing address

1221 SE 24TH ST
OKLAHOMA CITY OK
73129-6413
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-7244
  • Fax:
Mailing address:
  • Phone: 405-875-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: