Provider Demographics
NPI:1003221946
Name:BROADHEAD, SABINA (LAC)
Entity Type:Individual
Prefix:
First Name:SABINA
Middle Name:
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10438 DEMOCRACY LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4036
Mailing Address - Country:US
Mailing Address - Phone:917-686-4752
Mailing Address - Fax:
Practice Address - Street 1:10438 DEMOCRACY LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4036
Practice Address - Country:US
Practice Address - Phone:917-686-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist