Provider Demographics
NPI:1215483623
Name:CASTRO, SHARI ROSE (BA)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:ROSE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:ROSE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:2613 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3346
Mailing Address - Country:US
Mailing Address - Phone:918-841-5080
Mailing Address - Fax:
Practice Address - Street 1:2613 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3346
Practice Address - Country:US
Practice Address - Phone:918-841-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator