Healthcare Provider Details

I. General information

NPI: 1023016268
Provider Name (Legal Business Name): TERESA MARIE SHAVNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW EXPRESSWAY SUITE 420
OKLAHOMA CITY OK
73112-4493
US

IV. Provider business mailing address

3400 NW EXPRESSWAY SUITE 420
OKLAHOMA CITY OK
73112-4493
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9935
  • Fax: 405-713-9936
Mailing address:
  • Phone: 405-713-9935
  • Fax: 405-713-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12744
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: