Provider Demographics
NPI:1225711047
Name:OKENGWU, SANDRA BLESSING
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:BLESSING
Last Name:OKENGWU
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 1:9224 WHITE OAK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2G0E9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9224 WHITE OAK AVENUE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:ONTARIO
Practice Address - Zip Code:L2G0E9
Practice Address - Country:CA
Practice Address - Phone:416-278-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404837363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health