Provider Demographics
NPI:1629567615
Name:SANDRINE LUM AZINWI, FNU
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:SANDRINE LUM AZINWI
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 1:11441 CHERRY HILL RD APT 304
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3642
Mailing Address - Country:US
Mailing Address - Phone:240-470-9677
Mailing Address - Fax:
Practice Address - Street 1:11441 CHERRY HILL RD APT 304
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3642
Practice Address - Country:US
Practice Address - Phone:240-470-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13605374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide