Provider Demographics
NPI:1194381939
Name:SELLS, SHANNON YVETTE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:YVETTE
Last Name:SELLS
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 1:13331 N MACARTHUR BLVD APT 607
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-8811
Mailing Address - Country:US
Mailing Address - Phone:918-361-5916
Mailing Address - Fax:
Practice Address - Street 1:13331 N MACARTHUR BLVD APT 607
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-8811
Practice Address - Country:US
Practice Address - Phone:918-361-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK171M00000XMedicaid