MEDICARE: SHELLEY SUZANNE CRAGG ROZAS PA-C

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	363AM0700X	Medical Physician Assistant	1030	OK

General Provider Information

NPI Number	:	1720161698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY SUZANNE CRAGG ROZAS PA-C

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD STE 107
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8300
Country	:	US
Telephone Number	:	405-936-5888
Fax Number	:	405-936-5899

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD STE 107
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8300
Country	:	US
Telephone Number	:	405-936-5888
Fax Number	:	405-936-5899

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/02/2024

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