Healthcare Provider Details

I. General information

NPI: 1124634928
Provider Name (Legal Business Name): SANDRA OMOYE AKHAREYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W 1575 N APT 102
LOGAN UT
84341-5541
US

IV. Provider business mailing address

144 W 1575 N APT 102
LOGAN UT
84341-5541
US

V. Phone/Fax

Practice location:
  • Phone: 646-204-2342
  • Fax:
Mailing address:
  • Phone: 646-204-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: