Provider Demographics
NPI:1548448095
Name:OBONAGA, SHEILA (NP)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:OBONAGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2433
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2433
Mailing Address - Country:US
Mailing Address - Phone:212-216-6568
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:275 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1611
Practice Address - Country:US
Practice Address - Phone:212-463-0107
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304734363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health