Provider Demographics
NPI:1336424746
Name:BENJAMIN, SHEILA MARIE (CTRS)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 E 37TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3012
Mailing Address - Country:US
Mailing Address - Phone:918-809-5564
Mailing Address - Fax:
Practice Address - Street 1:1033 E 37TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3012
Practice Address - Country:US
Practice Address - Phone:918-809-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1336424746Medicaid