Provider Demographics
NPI:1699859561
Name:WASHINGTON, SANDRA P (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:P
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S BOYLAN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2246
Mailing Address - Country:US
Mailing Address - Phone:919-247-7503
Mailing Address - Fax:
Practice Address - Street 1:820 S BOYLAN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2246
Practice Address - Country:US
Practice Address - Phone:919-247-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2761073AMedicare ID - Type Unspecified
P44591Medicare ID - Type Unspecified