Basic Information
| Provider Information | |||||||||
| NPI: | 1144208877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBOSE-COOPER | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 338 HARDING AVE | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066157247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035020024 | ||||||||
| FaxNumber: | 2035799519 | ||||||||
| Practice Location | |||||||||
| Address1: | 982 E MAIN ST | ||||||||
| Address2: | OPTIMUS HEALTH CARE- SCHOOL-BASED HEALTH CENTERS | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066081913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035799519 | ||||||||
| FaxNumber: | 2035799519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 03/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 002167 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 004142361 | 05 | CT | MEDICAID |