Provider Demographics
NPI:1023420718
Name:SHOGBESAN, OLUWASEUN (MD)
Entity type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:
Last Name:SHOGBESAN
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 1:1901 S HAWTHORNE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3915
Mailing Address - Country:US
Mailing Address - Phone:336-448-2427
Mailing Address - Fax:
Practice Address - Street 1:1901 S HAWTHORNE RD STE 310
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3915
Practice Address - Country:US
Practice Address - Phone:336-448-2427
Practice Address - Fax:336-765-2869
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83321207R00000X
PAMD462198207R00000X
PAMT207173207R00000X
NC2023-00865207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine