Provider Demographics
NPI:1023016268
Name:SHAVNEY, TERESA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:SHAVNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4493
Mailing Address - Country:US
Mailing Address - Phone:405-713-9935
Mailing Address - Fax:405-713-9936
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:SUITE 420
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4493
Practice Address - Country:US
Practice Address - Phone:405-713-9935
Practice Address - Fax:405-713-9936
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK12744208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112140AMedicaid