Healthcare Provider Details

I. General information

NPI: 1043450448
Provider Name (Legal Business Name): VICTORIA SALAMY-SULLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

IV. Provider business mailing address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-0300
  • Fax:
Mailing address:
  • Phone: 405-447-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1812
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: