Provider Demographics
NPI:1891470035
Name:OKLAHOMA PEDIATRIC DIGESTIVE INSTITUTE, PLLC
Entity Type:Organization
Organization Name:OKLAHOMA PEDIATRIC DIGESTIVE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMBAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-245-8004
Mailing Address - Street 1:3300 NW 56TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4401
Mailing Address - Country:US
Mailing Address - Phone:405-844-5221
Mailing Address - Fax:
Practice Address - Street 1:3300 NW 56TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4401
Practice Address - Country:US
Practice Address - Phone:405-844-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty