Provider Demographics
NPI:1336746445
Name:CAGLE, SHALYN MARIE MAY
Entity Type:Individual
Prefix:
First Name:SHALYN
Middle Name:MARIE MAY
Last Name:CAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHALYN
Other - Middle Name:MARIE MAY
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1824 CYPRESS LN # 10
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5105
Mailing Address - Country:US
Mailing Address - Phone:405-274-4721
Mailing Address - Fax:
Practice Address - Street 1:1824 CYPRESS LN # 10
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5105
Practice Address - Country:US
Practice Address - Phone:405-274-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator