Healthcare Provider Details

I. General information

NPI: 1164046231
Provider Name (Legal Business Name): SANKOFA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LAUREL MD
20707-4114
US

IV. Provider business mailing address

15606 N PLATTE DR
BOWIE MD
20716-1361
US

V. Phone/Fax

Practice location:
  • Phone: 240-786-7182
  • Fax:
Mailing address:
  • Phone: 301-675-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARCUS PONDER
Title or Position: PRINCIPAL
Credential:
Phone: 301-675-9109