Provider Demographics
NPI:1871957696
Name:BEACH, SHAYLEA DAWN (D O)
Entity type:Individual
Prefix:
First Name:SHAYLEA
Middle Name:DAWN
Last Name:BEACH
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:SHAYLEA
Other - Middle Name:DAWN
Other - Last Name:RIDDLE SHEBESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 E ROBINSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6652
Mailing Address - Country:US
Mailing Address - Phone:405-515-1935
Mailing Address - Fax:405-310-4311
Practice Address - Street 1:701 E ROBINSON ST STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6652
Practice Address - Country:US
Practice Address - Phone:405-515-1935
Practice Address - Fax:405-310-4311
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK6254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program