Provider Demographics
NPI:1396833950
Name:O'DROBINAK, SIMONE K (PA)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:K
Last Name:O'DROBINAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:K
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-4000
Mailing Address - Fax:419-291-6430
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-4000
Practice Address - Fax:419-479-6962
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1071069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4954976Medicaid
OH0069457Medicaid
OHQ78607Medicare UPIN
OH0069457Medicaid