Provider Demographics
NPI:1144208877
Name:DUBOSE-COOPER, SHEILA (APRN)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:
Last Name:DUBOSE-COOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-7247
Mailing Address - Country:US
Mailing Address - Phone:203-502-0024
Mailing Address - Fax:203-579-9519
Practice Address - Street 1:982 E MAIN ST
Practice Address - Street 2:OPTIMUS HEALTH CARE- SCHOOL-BASED HEALTH CENTERS
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-1913
Practice Address - Country:US
Practice Address - Phone:203-579-9519
Practice Address - Fax:203-579-9519
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004142361Medicaid