Provider Demographics
NPI:1124382692
Name:SANDJONG, CHARLIE J
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:J
Last Name:SANDJONG
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 1:11700 OLD COLUMBIA PIKE APT 1410
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2556
Mailing Address - Country:US
Mailing Address - Phone:301-646-5390
Mailing Address - Fax:
Practice Address - Street 1:11700 OLD COLUMBIA PIKE APT 1410
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2556
Practice Address - Country:US
Practice Address - Phone:301-646-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide