Healthcare Provider Details

I. General information

NPI: 1134963515
Provider Name (Legal Business Name): ALEXANDRA VICTORIA SHUMARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5018
US

IV. Provider business mailing address

800 STANTON L YOUNG BLVD STE 6300
OKLAHOMA CITY OK
73104-5018
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5552
  • Fax:
Mailing address:
  • Phone: 405-271-8001
  • Fax: 405-271-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1108R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: