Healthcare Provider Details

I. General information

NPI: 1134488844
Provider Name (Legal Business Name): MRS. SONITA NULLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/17/2020
Certification Date: 05/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 PHILADELPHIA RD
JOPPA MD
21085-3216
US

IV. Provider business mailing address

1107 KINGWOOD DR
TAKOMA PARK MD
20912-6917
US

V. Phone/Fax

Practice location:
  • Phone: 240-705-3324
  • Fax:
Mailing address:
  • Phone: 240-705-3324
  • Fax: 202-503-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR217800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: