Provider Demographics
NPI:1609439264
Name:SANKOH, FATMATA ALIE
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:ALIE
Last Name:SANKOH
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 1:4800 MAURINE CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1204
Mailing Address - Country:US
Mailing Address - Phone:571-263-5428
Mailing Address - Fax:
Practice Address - Street 1:4800 MAURINE CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1204
Practice Address - Country:US
Practice Address - Phone:571-263-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities