Provider Demographics
NPI:1023371424
Name:OGANDO, HEATHER SHANNON (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:SHANNON
Last Name:OGANDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:135 PARK BLVD
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3643
Mailing Address - Country:US
Mailing Address - Phone:516-795-9090
Mailing Address - Fax:
Practice Address - Street 1:135 PARK BLVD
Practice Address - Street 2:BOX 308
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3643
Practice Address - Country:US
Practice Address - Phone:516-795-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY279789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine