Provider Demographics
NPI:1801616941
Name:KOLENCHERRY AUGUSTINE, SHEEJA MOLE
Entity type:Individual
Prefix:
First Name:SHEEJA MOLE
Middle Name:
Last Name:KOLENCHERRY AUGUSTINE
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 1:5936 STERLINGWORTH DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-0049
Mailing Address - Country:US
Mailing Address - Phone:570-702-7849
Mailing Address - Fax:
Practice Address - Street 1:5936 STERLINGWORTH DR
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-0049
Practice Address - Country:US
Practice Address - Phone:570-702-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191443163WG0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice