Provider Demographics
NPI:1326545583
Name:BUNDU, SIDRATU AMINATA (FNP)
Entity Type:Individual
Prefix:
First Name:SIDRATU
Middle Name:AMINATA
Last Name:BUNDU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMINATA
Other - Middle Name:
Other - Last Name:KOROMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7916 SCHUYLER CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5143
Mailing Address - Country:US
Mailing Address - Phone:571-338-1594
Mailing Address - Fax:
Practice Address - Street 1:7916 SCHUYLER CT
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5143
Practice Address - Country:US
Practice Address - Phone:571-338-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily