Provider Demographics
NPI:1770844771
Name:UPSHAW, SHARKISTA NASHAUN
Entity Type:Individual
Prefix:
First Name:SHARKISTA
Middle Name:NASHAUN
Last Name:UPSHAW
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 1:1815 N BOOMER RD
Mailing Address - Street 2:#A5
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-3402
Mailing Address - Country:US
Mailing Address - Phone:405-210-1999
Mailing Address - Fax:
Practice Address - Street 1:1815 N BOOMER RD
Practice Address - Street 2:#A5
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3402
Practice Address - Country:US
Practice Address - Phone:405-210-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst