Provider Demographics
NPI:1053662411
Name:BANKS, SANDRA YVETT
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:YVETT
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 KENNEDY ST NW STE 11
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5269
Mailing Address - Country:US
Mailing Address - Phone:202-290-3476
Mailing Address - Fax:202-290-3487
Practice Address - Street 1:143 KENNEDY ST NW STE 11
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5269
Practice Address - Country:US
Practice Address - Phone:202-290-3476
Practice Address - Fax:202-290-3487
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide