Provider Demographics
NPI:1093424640
Name:SHALANS HEALTH AND WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:SHALANS HEALTH AND WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALAN
Authorized Official - Middle Name:ASTASHIA
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:918-951-2666
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-0041
Mailing Address - Country:US
Mailing Address - Phone:918-951-2666
Mailing Address - Fax:
Practice Address - Street 1:3315 E 47TH PL STE 120
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2911
Practice Address - Country:US
Practice Address - Phone:918-951-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty