Provider Demographics
NPI:1245611854
Name:KUNCIW, SABRINA EMERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:EMERALD
Last Name:KUNCIW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NANDINA CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-8938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-907-6099
Practice Address - Street 1:121 CSH/BAACH
Practice Address - Street 2:BUILDING #17005
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:KR
Practice Address - Phone:012-746-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101261371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine