Healthcare Provider Details

I. General information

NPI: 1356679310
Provider Name (Legal Business Name): TORMEIKA SHONDEL SANFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHESAPEAKE DR
CAMBRIDGE MD
21613-9408
US

IV. Provider business mailing address

830 CHESAPEAKE DR
CAMBRIDGE MD
21613-9408
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-6243
  • Fax:
Mailing address:
  • Phone: 410-228-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR185953
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR185953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: