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General NPI Number Information
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NPI Number | 1942866439
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Entity Type | Individual
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Provider Name | SHALEA GUILLORY
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Gender | Female
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Dates
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Enumeration Date | 05/10/2019
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Last Update Date | 05/10/2019
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Provider Practice Location Address
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Address Line | 4300 S HARVARD AVE
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City | TULSA
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State | OK
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Zip | 74135-2619
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Country | US
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Telephone | 917-728-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 S 123RD EAST AVE
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City | TULSA
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State | OK
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Zip | 74129-5837
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Country | US
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Telephone | 323-449-7559
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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