Provider Demographics
NPI:1386256113
Name:DAYMUDE, SHANNAH
Entity type:Individual
Prefix:
First Name:SHANNAH
Middle Name:
Last Name:DAYMUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAY
Other - Middle Name:
Other - Last Name:DAYMUDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3929 24TH AVE SE APT 12
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-0813
Mailing Address - Country:US
Mailing Address - Phone:405-343-6585
Mailing Address - Fax:
Practice Address - Street 1:3929 24TH AVE SE APT 12
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-0813
Practice Address - Country:US
Practice Address - Phone:405-343-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator