Provider Demographics
NPI:1710782933
Name:HARRIS, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202639 E COUNTY ROAD 42
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-5442
Mailing Address - Country:US
Mailing Address - Phone:580-254-5322
Mailing Address - Fax:
Practice Address - Street 1:316 NORTHRIDGE CIR STE 3
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2762
Practice Address - Country:US
Practice Address - Phone:580-338-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist