Individual
SHANDI ALPHONSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1219 N.W. 9TH ST., OKC, OK 73106
(405) 448-8077
Mailing address
1219 NW 9TH ST, OKLAHOMA CITY, OK 73106-7009
(405) 448-8077
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B23337391
SOONERCARE
OK
Enumeration date
07/19/2016
Last updated
07/19/2016
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