Provider Demographics
NPI:1871706358
Name:MOHAMDI-OSMAN, SHERLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERLEEN
Middle Name:
Last Name:MOHAMDI-OSMAN
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:WAKE ISLAND DISPENSARY
Mailing Address - Street 2:
Mailing Address - City:WAKE ISLAND
Mailing Address - State:HI
Mailing Address - Zip Code:96898-5000
Mailing Address - Country:US
Mailing Address - Phone:845-821-2450
Mailing Address - Fax:808-424-2177
Practice Address - Street 1:WAKE ISLAND DISPENSARY
Practice Address - Street 2:
Practice Address - City:WAKE ISLAND
Practice Address - State:HI
Practice Address - Zip Code:96898-5000
Practice Address - Country:US
Practice Address - Phone:808-424-2455
Practice Address - Fax:808-424-2177
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186284207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY186284OtherLICENSE NUMBER
NYBO2850370OtherDEA NUMBER
NY41J131Medicare ID - Type Unspecified
NY186284OtherLICENSE NUMBER