Provider Demographics
NPI:1003202227
Name:RA, SANKOFA (DOULA,CLC,WSP,CHHP)
Entity Type:Individual
Prefix:MS
First Name:SANKOFA
Middle Name:
Last Name:RA
Suffix:
Gender:F
Credentials:DOULA,CLC,WSP,CHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 UNION AVE
Mailing Address - Street 2:APT. 1C
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5901
Mailing Address - Country:US
Mailing Address - Phone:914-484-6562
Mailing Address - Fax:
Practice Address - Street 1:290 UNION AVE
Practice Address - Street 2:APT. 1C
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5901
Practice Address - Country:US
Practice Address - Phone:914-484-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60813212174400000X
NYALPP-208931174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN