Provider Demographics
NPI:1023714235
Name:OLUBODE, SHEILIA
Entity type:Individual
Prefix:
First Name:SHEILIA
Middle Name:
Last Name:OLUBODE
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 1:1819 SAVANNAS RUN DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-1700
Mailing Address - Country:US
Mailing Address - Phone:336-907-3154
Mailing Address - Fax:336-907-1357
Practice Address - Street 1:1819 SAVANNAS RUN DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-1700
Practice Address - Country:US
Practice Address - Phone:336-907-3154
Practice Address - Fax:336-907-1357
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor