Healthcare Provider Details

I. General information

NPI: 1679239206
Provider Name (Legal Business Name): SONIA UCHECHUKWU OKOLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 07/02/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N ST SE BLDG 175
WASHINGTON DC
20374-5162
US

IV. Provider business mailing address

915 N ST SE BLDG 175
WASHINGTON DC
20374-5162
US

V. Phone/Fax

Practice location:
  • Phone: 24-332-6402
  • Fax:
Mailing address:
  • Phone: 202-433-6364
  • Fax: 202-433-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008232
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberPA200001327
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: