Healthcare Provider Details

I. General information

NPI: 1053087866
Provider Name (Legal Business Name): SANDRA IHEANACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST NE FL 10
WASHINGTON DC
20002-7954
US

IV. Provider business mailing address

2000 TOWER OAKS BLVD STE 500
ROCKVILLE MD
20852-4377
US

V. Phone/Fax

Practice location:
  • Phone: 202-442-5885
  • Fax:
Mailing address:
  • Phone: 301-444-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP200001920
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: