Provider Demographics
NPI:1962445551
Name:LOBO, SHIREEN A (DO)
Entity Type:Individual
Prefix:
First Name:SHIREEN
Middle Name:A
Last Name:LOBO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6654
Practice Address - Fax:864-560-7388
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239380207R00000X
PAOS014302207R00000X, 208M00000X
SC37722207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC377229Medicaid
PA102083201 0003Medicaid
NY02759828Medicaid
PA121202YEJFMedicare PIN
SCSC66305019Medicare PIN
PA121202VP6Medicare PIN
NY02759828Medicaid
NY02759828Medicaid