Provider Demographics
NPI:1336229806
Name:LOEB, SHEILA L (CNM)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
Last Name:LOEB
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2758
Mailing Address - Country:US
Mailing Address - Phone:718-960-1546
Mailing Address - Fax:718-960-2123
Practice Address - Street 1:MMG - GRAND CONCOURSE
Practice Address - Street 2:2532 GRAND CONCOURSE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-960-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000268367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife