Provider Demographics
NPI:1467880377
Name:LOVE, SHUNDRICKA
Entity Type:Individual
Prefix:
First Name:SHUNDRICKA
Middle Name:
Last Name:LOVE
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 1:16600 VALLEY CRST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6723
Mailing Address - Country:US
Mailing Address - Phone:405-924-2078
Mailing Address - Fax:
Practice Address - Street 1:1311 N LOTTIE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-2051
Practice Address - Country:US
Practice Address - Phone:405-600-3074
Practice Address - Fax:405-605-8120
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator