Provider Demographics
NPI:1720161698
Name:CRAGG ROZAS, SHELLEY SUZANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SUZANNE
Last Name:CRAGG ROZAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:SUZANNE
Other - Last Name:WEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4140 W MEMORIAL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8300
Mailing Address - Country:US
Mailing Address - Phone:405-936-5888
Mailing Address - Fax:405-936-5899
Practice Address - Street 1:4140 W MEMORIAL RD STE 107
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8300
Practice Address - Country:US
Practice Address - Phone:405-936-5888
Practice Address - Fax:405-936-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1030363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical