Provider Demographics
NPI:1275098238
Name:AJAKAYE, SANDRA CLARENCIA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CLARENCIA
Last Name:AJAKAYE
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 1:209 63RD DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7663
Mailing Address - Country:US
Mailing Address - Phone:941-504-4011
Mailing Address - Fax:
Practice Address - Street 1:8051 N TAMIAMI TRL # D5
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2032
Practice Address - Country:US
Practice Address - Phone:941-779-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9284796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse