Provider Demographics
NPI:1396520680
Name:SHEKINAH NUTRITION
Entity type:Organization
Organization Name:SHEKINAH NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARESE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL KALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-413-8227
Mailing Address - Street 1:2301 NW 122ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8447
Mailing Address - Country:US
Mailing Address - Phone:405-413-8227
Mailing Address - Fax:
Practice Address - Street 1:2301 NW 122ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8447
Practice Address - Country:US
Practice Address - Phone:405-413-8227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty