Healthcare Provider Details

I. General information

NPI: 1952254674
Provider Name (Legal Business Name): SANDY M JAMBAWAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW # 360
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

103 SUMMIT AVENUE, THURMONT
THURMONT MD
21788-1870
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-8494
  • Fax: 202-851-5002
Mailing address:
  • Phone: 732-917-5248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: