Provider Demographics
NPI:1114966157
Name:SHONOWO, OWOBAMISHOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OWOBAMISHOLA
Middle Name:
Last Name:SHONOWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863
Mailing Address - Country:US
Mailing Address - Phone:848-203-3520
Mailing Address - Fax:
Practice Address - Street 1:565 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2162
Practice Address - Country:US
Practice Address - Phone:848-203-3520
Practice Address - Fax:848-203-3627
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07930600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ274327299OtherTAX ID#
NJ7546474OtherAETNA PPO ID #
NJP3653473OtherOXFORD ID #
NJ1118997OtherAETNA HMO ID #
NJ2678996000OtherAMERIHEALTH #
NJ8223752OtherGHI PPO #
NJ108925TDXMedicare PIN
NJH96404Medicare UPIN