Healthcare Provider Details

I. General information

NPI: 1144455874
Provider Name (Legal Business Name): SHORMEH YEBOAH OTSIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHORMEH ODOFOLEY YEBOAH MD

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LANSDOWNE AVE FL 1
DARBY PA
19023-1333
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 610-534-6310
  • Fax:
Mailing address:
  • Phone: 804-822-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD445351
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: