Provider Information for 1417274655
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SHAUNTA GILLS-ROBERSON
Other Names:Former Name:SHAUNTA GILLSSex: Female
NPI: 1417274655
Last Updated: 2020-01-14
Certification Date: 2020-01-14
Certification Date: 2020-01-14
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417274655 | ||||||||||||||
| Enumeration Date | 2010-04-28 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | PO BOX 721627 OKLAHOMA CITY, OK 73172-1627 United States Phone: 405-684-3104 | Fax: | ||||||||||||||
| Primary Practice Address | 1016 SW 44TH ST STE 500 OKLAHOMA CITY, OK 73109-3615 United States Phone: 405-605-4249 | Fax:405-605-0255 | ||||||||||||||
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