Healthcare Provider Details

I. General information

NPI: 1982378741
Provider Name (Legal Business Name): SHARON KARJADI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

2401 W MOBILE PL
BROKEN ARROW OK
74011-8268
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4876
  • Fax:
Mailing address:
  • Phone: 918-574-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: