Provider Demographics
NPI:1063035178
Name:STARNES, SHALLETTE R
Entity Type:Individual
Prefix:
First Name:SHALLETTE
Middle Name:R
Last Name:STARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-1316
Mailing Address - Country:US
Mailing Address - Phone:405-754-9722
Mailing Address - Fax:
Practice Address - Street 1:3120 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1316
Practice Address - Country:US
Practice Address - Phone:405-754-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator