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General NPI Number Information
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NPI Number | 1265744056
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Entity Type | Individual
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Provider Name | SHELEATHA TAYLOR-BRISTOW M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 721 W BRITTON RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-2909
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Country | US
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Telephone | 405-632-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 N GRAND BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-1818
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Country | US
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Telephone | 56-326-6884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27765
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License Number State | OK
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