Healthcare Provider Details

I. General information

NPI: 1568734002
Provider Name (Legal Business Name): SHALONDRA HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NE 46TH ST
OKLAHOMA CITY OK
73105-3309
US

IV. Provider business mailing address

1301 W HEFNER RD APT 1201
OKLAHOMA CITY OK
73114-7121
US

V. Phone/Fax

Practice location:
  • Phone: 405-602-6331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: