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NPI Code Detail

MEDICARE: SHYVONNE NASHELLE-RUTH GRAY MD

MEDICARE: SHYVONNE NASHELLE-RUTH GRAY MD
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
12084P0800XPsychiatry Physician27895OK

General Provider Information

NPI Number : 1639490618
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHYVONNE NASHELLE-RUTH GRAY MD
Provider Business Mailing Address
First Line : 4013 NW EXPRESSWAY STE 105
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-2618
Country : US
Telephone Number : 405-378-2727
Fax Number :
Provider Business Practice Location Address
First Line : 4013 NW EXPRESSWAY STE 105
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-2618
Country : US
Telephone Number : 405-378-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2010
Last Update Date : 01/21/2026

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