Provider Demographics
NPI:1184178253
Name:SHAW, TINA ZELL
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ZELL
Last Name:SHAW
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 1:2500 THOMAS DR APT 712
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2274
Mailing Address - Country:US
Mailing Address - Phone:405-414-1404
Mailing Address - Fax:
Practice Address - Street 1:2500 THOMAS DR APT 712
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2274
Practice Address - Country:US
Practice Address - Phone:405-414-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator