Provider Demographics
NPI:1518444553
Name:LEE- AKEREDOLU, RACHEL SHALL (ETC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:SHALL
Last Name:LEE- AKEREDOLU
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W WACO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-3623
Mailing Address - Country:US
Mailing Address - Phone:918-237-2540
Mailing Address - Fax:
Practice Address - Street 1:118 WEST WACO STREET
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-7401
Practice Address - Country:US
Practice Address - Phone:918-237-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator