Provider Demographics
NPI:1598537755
Name:MAPOKAM, SANDRINE LAURE DEIGHELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SANDRINE LAURE
Middle Name:DEIGHELA
Last Name:MAPOKAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3438
Mailing Address - Country:US
Mailing Address - Phone:240-706-2941
Mailing Address - Fax:
Practice Address - Street 1:5140 RIVER CLUB DR STE 102
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3799
Practice Address - Country:US
Practice Address - Phone:757-977-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily