Provider Demographics
NPI:1386061018
Name:DEJEAR, SHANTAE
Entity type:Individual
Prefix:MS
First Name:SHANTAE
Middle Name:
Last Name:DEJEAR
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 1:1025 NW 86TH ST
Mailing Address - Street 2:APT 301
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2191
Mailing Address - Country:US
Mailing Address - Phone:405-802-6263
Mailing Address - Fax:
Practice Address - Street 1:1025 NW 86TH ST
Practice Address - Street 2:APT 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2191
Practice Address - Country:US
Practice Address - Phone:405-802-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst