Provider Demographics
NPI:1417795980
Name:SHEEDER, TRAVIS A
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:A
Last Name:SHEEDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 ELM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-6516
Mailing Address - Country:US
Mailing Address - Phone:918-630-9207
Mailing Address - Fax:
Practice Address - Street 1:1760 NEWBLOCK PARK DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-8427
Practice Address - Country:US
Practice Address - Phone:918-630-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist