Provider Demographics
NPI:1275032906
Name:RICHBURG, SHEILA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIANE
Last Name:RICHBURG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CARVER LOOP
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2946
Mailing Address - Country:US
Mailing Address - Phone:917-319-6758
Mailing Address - Fax:
Practice Address - Street 1:140 CARVER LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2946
Practice Address - Country:US
Practice Address - Phone:917-319-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401200-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse