Healthcare Provider Details

I. General information

NPI: 1407312259
Provider Name (Legal Business Name): MS. SHARISSE OBANION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 BARRINGTON CT
BOWIE MD
20721-2700
US

IV. Provider business mailing address

1826 BARRINGTON CT
BOWIE MD
20721-2700
US

V. Phone/Fax

Practice location:
  • Phone: 240-484-3203
  • Fax:
Mailing address:
  • Phone: 240-484-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: