Healthcare Provider Details

I. General information

NPI: 1548448095
Provider Name (Legal Business Name): SHEILA OBONAGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 8TH AVE
NEW YORK NY
10011-1611
US

IV. Provider business mailing address

PO BOX 95000-2433
PHILADELPHIA PA
19195-2433
US

V. Phone/Fax

Practice location:
  • Phone: 212-463-0107
  • Fax: 212-216-6606
Mailing address:
  • Phone: 212-216-6568
  • Fax: 212-216-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: