Provider Demographics
NPI:1841189925
Name:ANDERSON, MATTHEW SHELTON
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHELTON
Last Name:ANDERSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 POPPEY PL
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5674
Mailing Address - Country:US
Mailing Address - Phone:405-491-5837
Mailing Address - Fax:
Practice Address - Street 1:1100 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1200
Practice Address - Country:US
Practice Address - Phone:405-271-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program