Provider Demographics
NPI:1407312259
Name:OBANION, SHARISSE
Entity Type:Individual
Prefix:MS
First Name:SHARISSE
Middle Name:
Last Name:OBANION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 BARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2700
Mailing Address - Country:US
Mailing Address - Phone:240-484-3203
Mailing Address - Fax:
Practice Address - Street 1:1826 BARRINGTON CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2700
Practice Address - Country:US
Practice Address - Phone:240-484-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities