Healthcare Provider Details

I. General information

NPI: 1154942290
Provider Name (Legal Business Name): JESSICA SHENOI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

1200 CHILDRENS AVE FL 11
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5321
  • Fax:
Mailing address:
  • Phone: 405-769-8199
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number50472
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number100549
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: