Healthcare Provider Details

I. General information

NPI: 1316211154
Provider Name (Legal Business Name): SANDRA OGBONNAYA-WHITTLESEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

10 CENTER DR BLDG 10
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-7168
  • Fax:
Mailing address:
  • Phone: 301-496-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA122336
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA122336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: