Provider Demographics
NPI:1275782484
Name:ABRAHAM, SHEEBA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEEBA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4915
Mailing Address - Country:US
Mailing Address - Phone:770-664-9600
Mailing Address - Fax:770-664-9856
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:ST PETERS UNIVERSITY HOSPITAL
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00138700363AS0400X
GA9589363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ176711ZCAMMedicare PIN