Healthcare Provider Details

I. General information

NPI: 1801472071
Provider Name (Legal Business Name): SANDRA OKONKWO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA CHINENYE OKONKWO

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S CHERRY ROAD
ROCK HILL SC
29732-3487
US

IV. Provider business mailing address

628 BARCROFT LN
FORT MILL SC
29715-6228
US

V. Phone/Fax

Practice location:
  • Phone: 732-791-8177
  • Fax:
Mailing address:
  • Phone: 732-791-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number93100
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: