Provider Demographics
NPI:1093918575
Name:BETSY SHADID M.D., PLLC
Entity Type:Organization
Organization Name:BETSY SHADID M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-471-4047
Mailing Address - Street 1:13820 WIRELESS WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-471-4047
Mailing Address - Fax:
Practice Address - Street 1:13820 WIRELESS WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-471-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK250972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty