Healthcare Provider Details

I. General information

NPI: 1942983762
Provider Name (Legal Business Name): MBALU SANKOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 POGONIA CT
HYATTSVILLE MD
20784-1888
US

IV. Provider business mailing address

3707 POGONIA CT
HYATTSVILLE MD
20784-1888
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-6177
  • Fax:
Mailing address:
  • Phone: 240-413-6777
  • Fax: 410-946-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA15677
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: