Provider Demographics
NPI:1417395831
Name:SAMBALO, BIRAME J
Entity Type:Individual
Prefix:MR
First Name:BIRAME
Middle Name:J
Last Name:SAMBALO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE STE 504F
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3277
Mailing Address - Country:US
Mailing Address - Phone:301-560-1352
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 504F
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3277
Practice Address - Country:US
Practice Address - Phone:301-560-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC20025164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse