Provider Demographics
NPI:1639939507
Name:HAYES, SHANNAN DEMITRIA RENEA
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:DEMITRIA RENEA
Last Name:HAYES
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 1:4870 E 68TH ST UNIT 234
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4951
Mailing Address - Country:US
Mailing Address - Phone:330-217-7412
Mailing Address - Fax:
Practice Address - Street 1:4870 E 68TH ST UNIT 234
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4951
Practice Address - Country:US
Practice Address - Phone:330-217-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator