Provider Demographics
NPI:1114233251
Name:SANDY, JOHN P
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:SANDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 COLORADO AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3731
Mailing Address - Country:US
Mailing Address - Phone:610-529-2200
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 232
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5353
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG08619104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker