Provider Demographics
NPI:1548735525
Name:SARMIENTO, NELIA
Entity Type:Individual
Prefix:
First Name:NELIA
Middle Name:
Last Name:SARMIENTO
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 1:9728 HICKORYHURST DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4813
Mailing Address - Country:US
Mailing Address - Phone:443-317-7268
Mailing Address - Fax:
Practice Address - Street 1:9114 PHILADELPHIA RD
Practice Address - Street 2:STE 214
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4348
Practice Address - Country:US
Practice Address - Phone:443-977-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11566332084P0800X, 363AM0700X
1156633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant