Healthcare Provider Details

I. General information

NPI: 1104772482
Provider Name (Legal Business Name): RENAISSANCE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 NW 63RD ST STE E
OKLAHOMA CITY OK
73116-2041
US

IV. Provider business mailing address

3621 NW 63RD ST STE E
OKLAHOMA CITY OK
73116-2041
US

V. Phone/Fax

Practice location:
  • Phone: 405-345-2982
  • Fax:
Mailing address:
  • Phone: 405-345-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BHAVI SHAH
Title or Position: OWNER
Credential: DNP, ANP-C
Phone: 405-410-2720