MEDICARE: MRS. SANDRA KAY ASHOFF APRN, BC

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	R083963	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CL4644	OTHER	MD	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1992792428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA KAY ASHOFF APRN, BC

Provider Business Mailing Address
First Line	:	913 MEADOWGREEN DR
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5679
Country	:	US
Telephone Number	:	301-831-5089
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 SHADY GROVE CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1308
Country	:	US
Telephone Number	:	301-963-0060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	11/07/2007

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