Provider Demographics
NPI:1922125442
Name:OBEY, SHAWANDA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWANDA
Middle Name:RENEE
Last Name:OBEY
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 1:10801 FOOTHILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7695
Mailing Address - Country:US
Mailing Address - Phone:909-736-9091
Mailing Address - Fax:909-360-1094
Practice Address - Street 1:10801 FOOTHILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7695
Practice Address - Country:US
Practice Address - Phone:909-736-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC138882207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI18137Medicare UPIN
TX8C6204Medicare ID - Type Unspecified
TX8C6204Medicare ID - Type Unspecified
IN201219160Medicaid