Provider Demographics
NPI:1780688150
Name:SHETH, AVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:AVANI
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W MEMORIAL RD
Mailing Address - Street 2:STE 302
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1506
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:STE 305
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-841-7899
Practice Address - Fax:405-749-9779
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14599208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK050063896OtherMEDICARE RR
OK100821950BMedicaid
OK208041773001OtherBC/BS
OKP00424369OtherMEDICARE RR
OKP00424369OtherMEDICARE RR
OK100821950BMedicaid
OK5592440001Medicare NSC