Provider Demographics
NPI:1861252959
Name:DEMERY, AJASHA IRENE (MAB)
Entity type:Individual
Prefix:
First Name:AJASHA
Middle Name:IRENE
Last Name:DEMERY
Suffix:
Gender:F
Credentials:MAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E 141ST PL
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3624
Mailing Address - Country:US
Mailing Address - Phone:918-759-7472
Mailing Address - Fax:
Practice Address - Street 1:614 E 141ST PL
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3624
Practice Address - Country:US
Practice Address - Phone:918-759-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management