Provider Demographics
NPI:1811768021
Name:MASHANEY, COREY MICHAEL
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:MICHAEL
Last Name:MASHANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5814
Mailing Address - Country:US
Mailing Address - Phone:918-302-0052
Mailing Address - Fax:918-302-0085
Practice Address - Street 1:602 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5814
Practice Address - Country:US
Practice Address - Phone:918-302-0052
Practice Address - Fax:918-302-0085
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist