Healthcare Provider Details

I. General information

NPI: 1609858877
Provider Name (Legal Business Name): SHEILA J. STANEK, D.O., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W 7TH AVE STE 102
STILLWATER OK
74074-4300
US

IV. Provider business mailing address

1411 W 7TH AVE STE 102
STILLWATER OK
74074-4300
US

V. Phone/Fax

Practice location:
  • Phone: 405-377-8367
  • Fax: 405-377-5628
Mailing address:
  • Phone: 405-377-8367
  • Fax: 405-377-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number3222
License Number StateOK

VIII. Authorized Official

Name: DR. SHEILA JOANN STANEK
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 405-377-8367