Healthcare Provider Details

I. General information

NPI: 1538417217
Provider Name (Legal Business Name): MS. SAO Y BANGURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

1001 MADISON ST
ALEXANDRIA VA
22314-1630
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 571-233-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA7292
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: