Healthcare Provider Details

I. General information

NPI: 1114461605
Provider Name (Legal Business Name): SUNKARIE MANSARAY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9875 GOOD LUCK RD APT 8
LANHAM MD
20706-3231
US

IV. Provider business mailing address

9875 GOOD LUCK RD APT 8
LANHAM MD
20706-3231
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-4337
  • Fax: 301-277-4335
Mailing address:
  • Phone: 301-277-4337
  • Fax: 301-277-4335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberA00133602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: