Provider Demographics
NPI:1245683929
Name:ALPHONSO, SHANDI
Entity type:Individual
Prefix:
First Name:SHANDI
Middle Name:
Last Name:ALPHONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANDI
Other - Middle Name:
Other - Last Name:BARROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1219 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7009
Mailing Address - Country:US
Mailing Address - Phone:405-448-8077
Mailing Address - Fax:
Practice Address - Street 1:1219 N.W. 9TH ST.
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73106
Practice Address - Country:US
Practice Address - Phone:405-448-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKB23337391OtherSOONERCARE