1689854556 NPI number — DR. SHANA SPECTOR DENEEN N.D., ACUPUNCTURIST

Table of content: DR. SHANA SPECTOR DENEEN N.D., ACUPUNCTURIST (NPI 1689854556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689854556 NPI number — DR. SHANA SPECTOR DENEEN N.D., ACUPUNCTURIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENEEN
Provider First Name:
SHANA
Provider Middle Name:
SPECTOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D., ACUPUNCTURIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPECTOR
Provider Other First Name:
SHANA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689854556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4429 E 13TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74112-6101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-283-7430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4157 S HARVARD AVE STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-884-6005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  07-1006 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)