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NPI Code Detail

MEDICARE: MACKENZIE SHAMBURG

MEDICARE: MACKENZIE SHAMBURG
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
1106S00000XBehavior TechnicianRBT-26-518325OK

General Provider Information

NPI Number : 1750237921
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE SHAMBURG
Provider Business Mailing Address
First Line : 101 NE 53RD ST APT 2713
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-1862
Country : US
Telephone Number : 580-548-7003
Fax Number :
Provider Business Practice Location Address
First Line : 1717 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5103
Country : US
Telephone Number : 580-548-7003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ MACKENZIE SHAMBURG ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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