Provider Demographics
NPI:1467009225
Name:SANOGO, ASSITA
Entity Type:Individual
Prefix:
First Name:ASSITA
Middle Name:
Last Name:SANOGO
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 1:19449 RAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6257
Mailing Address - Country:US
Mailing Address - Phone:301-532-6344
Mailing Address - Fax:
Practice Address - Street 1:19449 RAYFIELD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-6257
Practice Address - Country:US
Practice Address - Phone:301-532-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14506374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide