Provider Demographics
NPI:1043030299
Name:O'MARA, SHENIKA (NP)
Entity type:Individual
Prefix:MRS
First Name:SHENIKA
Middle Name:
Last Name:O'MARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHENIKA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13650 NW 4TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2250
Mailing Address - Country:US
Mailing Address - Phone:973-980-4658
Mailing Address - Fax:
Practice Address - Street 1:13650 NW 4TH ST APT 303
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2250
Practice Address - Country:US
Practice Address - Phone:973-980-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily