Provider Demographics
NPI:1609858877
Name:SHEILA J. STANEK, D.O., PC
Entity Type:Organization
Organization Name:SHEILA J. STANEK, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:STANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-377-8367
Mailing Address - Street 1:1411 W 7TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4300
Mailing Address - Country:US
Mailing Address - Phone:405-377-8367
Mailing Address - Fax:405-377-5628
Practice Address - Street 1:1411 W 7TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4300
Practice Address - Country:US
Practice Address - Phone:405-377-8367
Practice Address - Fax:405-377-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
OK3222261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100138090AMedicaid
OK200389520AMedicaid
OKF92325Medicare UPIN
OKOKA103453Medicare PIN