Provider Demographics
NPI:1235242488
Name:SANDI, NABIATU (PA)
Entity Type:Individual
Prefix:
First Name:NABIATU
Middle Name:
Last Name:SANDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3227
Mailing Address - Country:US
Mailing Address - Phone:301-464-6364
Mailing Address - Fax:
Practice Address - Street 1:829 LINDEN AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-269-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30198363A00000X
MDC02453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant