Provider Demographics
NPI:1154819977
Name:SANDY, JOHANESE (DNP, PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JOHANESE
Middle Name:
Last Name:SANDY
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC, FNP-C
Other - Prefix:DR
Other - First Name:JOHANESE
Other - Middle Name:
Other - Last Name:SANDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, PMHNP-BC, FNP-C
Mailing Address - Street 1:14300 GALLANT FOX LN STE 207
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4033
Mailing Address - Country:US
Mailing Address - Phone:240-260-3147
Mailing Address - Fax:240-885-8733
Practice Address - Street 1:14300 GALLANT FOX LN STE 207
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4033
Practice Address - Country:US
Practice Address - Phone:240-260-3147
Practice Address - Fax:240-885-8733
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183268363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily