Healthcare Provider Details

I. General information

NPI: 1407521933
Provider Name (Legal Business Name): SOSAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-2493
US

IV. Provider business mailing address

700 PENNSYLVANIA AVE SE FL 2
WASHINGTON DC
20003-2493
US

V. Phone/Fax

Practice location:
  • Phone: 800-681-4180
  • Fax:
Mailing address:
  • Phone: 800-681-4180
  • Fax: 800-681-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: SHENITA-ANN PATRECE GRYMES
Title or Position: OWNER, HEALTH COACH
Credential: CHC
Phone: 800-681-4180