Provider Demographics
NPI:1659756021
Name:SIJUADE, VICTORIA (CPNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SIJUADE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 HONEYGO CENTER DRIVE
Mailing Address - Street 2:STE. 225
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128
Mailing Address - Country:US
Mailing Address - Phone:702-641-8500
Mailing Address - Fax:702-641-8502
Practice Address - Street 1:5009 HONEYGO CENTER DRIVE
Practice Address - Street 2:STE. 225
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128
Practice Address - Country:US
Practice Address - Phone:702-641-8500
Practice Address - Fax:702-641-8502
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001899363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics