Provider Demographics
NPI:1629660030
Name:SASU, GLORIA ASANTEWAH
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ASANTEWAH
Last Name:SASU
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:ASANTEWAH
Other - Last Name:SASU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8204 GORMAN AVE 149
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-821-7039
Mailing Address - Fax:
Practice Address - Street 1:8204 GORMAN AVE APT 149
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-2514
Practice Address - Country:US
Practice Address - Phone:301-821-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171000000XOther Service ProvidersMilitary Health Care Provider
No174H00000XOther Service ProvidersHealth Educator
No176B00000XOther Service ProvidersMidwife
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00000000OtherDOD