Provider Demographics
NPI:1508316530
Name:STEARS, SHAYNIEL (PA)
Entity Type:Individual
Prefix:
First Name:SHAYNIEL
Middle Name:
Last Name:STEARS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHAYNIEL
Other - Middle Name:
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5410
Mailing Address - Country:US
Mailing Address - Phone:918-748-7585
Mailing Address - Fax:
Practice Address - Street 1:16201 GOSSAMER WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-1503
Practice Address - Country:US
Practice Address - Phone:208-709-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical