Healthcare Provider Details

I. General information

NPI: 1487467049
Provider Name (Legal Business Name): SANDRA UGOCHI ENYINNAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47624 LINDENHURST BLVD
CANTON MI
48188-3291
US

IV. Provider business mailing address

47624 LINDENHURST BLVD
CANTON MI
48188-3291
US

V. Phone/Fax

Practice location:
  • Phone: 248-818-3769
  • Fax:
Mailing address:
  • Phone: 248-818-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: