Provider Demographics
NPI:1922546258
Name:SOBAH, OPHELIA W
Entity Type:Individual
Prefix:
First Name:OPHELIA
Middle Name:W
Last Name:SOBAH
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 1:15 PRESTBURY SQ
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2608
Mailing Address - Country:US
Mailing Address - Phone:302-368-2273
Mailing Address - Fax:
Practice Address - Street 1:15 PRESTBURY SQ
Practice Address - Street 2:SUITE 14
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2608
Practice Address - Country:US
Practice Address - Phone:302-368-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0011585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse