MEDICARE: SANDRA OPPONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508228511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA OPPONG

Provider Business Mailing Address
First Line	:	2004 LAFONTAINE AVE
Second Line	:	FLOOR 3
City	:	BRONX
State	:	NY
Zip	:	10457-4700
Country	:	US
Telephone Number	:	646-359-3998
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 LAFONTAINE AVE
Second Line	:	FLOOR 3
City	:	BRONX
State	:	NY
Zip	:	10457-4700
Country	:	US
Telephone Number	:	646-359-3998
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	SANDRA KONADU OPPONG
Credential	:
Telephone Number	:	646-359-3998

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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