Healthcare Provider Details

I. General information

NPI: 1669864740
Provider Name (Legal Business Name): SARAH GWANYALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SYMPHONY WOODS DR
SILVER SPRING MD
20901-5028
US

IV. Provider business mailing address

705 SYMPHONY WOODS DR
SILVER SPRING MD
20901-5028
US

V. Phone/Fax

Practice location:
  • Phone: 301-273-5587
  • Fax: 301-273-5587
Mailing address:
  • Phone: 301-273-5587
  • Fax: 301-273-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberNA00051846
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: