Healthcare Provider Details

I. General information

NPI: 1619278215
Provider Name (Legal Business Name): MWATA SANKARA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N PINE HILLS RD
ORLANDO FL
32808-4832
US

IV. Provider business mailing address

1316 N PINE HILLS RD # 101
ORLANDO FL
32808-4832
US

V. Phone/Fax

Practice location:
  • Phone: 202-425-6681
  • Fax:
Mailing address:
  • Phone: 202-425-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY8137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: