Healthcare Provider Details

I. General information

NPI: 1861806523
Provider Name (Legal Business Name): BRIAN SHAYOTA M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 5D
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

100 HALSTED ST APT 304
EAST ORANGE NJ
07018-2754
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4211
  • Fax: 405-271-2263
Mailing address:
  • Phone: 917-565-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11745596-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number46385
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number11745596-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: