MEDICARE: SHALONDA FIELDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083222194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALONDA FIELDS

Provider Business Mailing Address
First Line	:	8913 NW 82ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4018
Country	:	US
Telephone Number	:	405-801-7786
Fax Number	:

Provider Business Practice Location Address
First Line	:	8913 NW 82ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4018
Country	:	US
Telephone Number	:	405-801-7786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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Directions to “ SHALONDA FIELDS ” Practice Location

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