Healthcare Provider Details

I. General information

NPI: 1497035281
Provider Name (Legal Business Name): MRS. SHALONDA R PHILLIPS-EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5107
US

IV. Provider business mailing address

236 RANDALL DR
MIDWEST CITY OK
73110-4644
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-7711
  • Fax:
Mailing address:
  • Phone: 405-570-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: