Healthcare Provider Details

I. General information

NPI: 1699396077
Provider Name (Legal Business Name): SHERILYN NICOLE ELLERBEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 6TH AVE
STILLWATER OK
74074-4202
US

IV. Provider business mailing address

1815 W 6TH AVE
STILLWATER OK
74074-4202
US

V. Phone/Fax

Practice location:
  • Phone: 405-743-7300
  • Fax:
Mailing address:
  • Phone: 405-743-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39709
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021022684
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-10784
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: