Healthcare Provider Details

I. General information

NPI: 1689660896
Provider Name (Legal Business Name): SHALINI SANGAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W CHEROKEE ST
WAGONER OK
74467-4624
US

IV. Provider business mailing address

384 S 33RD ST STE B
MUSKOGEE OK
74401-5065
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-0700
  • Fax:
Mailing address:
  • Phone: 918-682-0700
  • Fax: 918-682-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17509
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: