Healthcare Provider Details

I. General information

NPI: 1013343359
Provider Name (Legal Business Name): SHAUNTE ANGELIQUE DURON-OKOTETE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 NE BEACON DR
GRANTS PASS OR
97526-3840
US

IV. Provider business mailing address

1564 KOKANEE LN
GRANTS PASS OR
97527-6432
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-6821
  • Fax:
Mailing address:
  • Phone: 541-840-9712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: