Provider Demographics
NPI:1457379331
Name:PONGNON, SHEILA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:D
Last Name:PONGNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 STEVENS AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-665-2229
Mailing Address - Fax:914-840-1341
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-665-2229
Practice Address - Fax:914-840-1341
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY238292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822957Medicaid
I65258Medicare UPIN
NY6395V1Medicare PIN