Provider Demographics
NPI:1497017263
Name:SAJOUS, SERGE DANIEL
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:DANIEL
Last Name:SAJOUS
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 1:7820 EMILYS WAY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2460
Mailing Address - Country:US
Mailing Address - Phone:240-715-5958
Mailing Address - Fax:
Practice Address - Street 1:7820 EMILYS WAY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2460
Practice Address - Country:US
Practice Address - Phone:240-715-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide