Provider Demographics
NPI:1104559756
Name:VELEZ COPE, SHALAN ASTASHIA (FNP)
Entity type:Individual
Prefix:
First Name:SHALAN
Middle Name:ASTASHIA
Last Name:VELEZ COPE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHALAN
Other - Middle Name:ASTASHIA
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5919 W 590
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-5403
Mailing Address - Country:US
Mailing Address - Phone:918-951-2666
Mailing Address - Fax:
Practice Address - Street 1:5919 W 590
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337-5403
Practice Address - Country:US
Practice Address - Phone:918-951-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily