Provider Demographics
NPI:1083742506
Name:BURKE, SHAYE L (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAYE
Middle Name:L
Last Name:BURKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHAYE
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3008 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7800
Mailing Address - Country:US
Mailing Address - Phone:918-557-9242
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-9923
Practice Address - Country:US
Practice Address - Phone:918-557-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine