Provider Demographics
NPI:1699380089
Name:COOPER, SUNNY SHIRENE
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:SHIRENE
Last Name:COOPER
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 1:51 DOVE RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-7368
Mailing Address - Country:US
Mailing Address - Phone:405-408-9096
Mailing Address - Fax:
Practice Address - Street 1:9933 E 61ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1504
Practice Address - Country:US
Practice Address - Phone:405-408-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist