Provider Demographics
NPI:1801415815
Name:MOMOH-ANABA, SANDRA R
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:MOMOH-ANABA
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 1:525 TOWNE SQUARE WAY APT 1516
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6791
Mailing Address - Country:US
Mailing Address - Phone:321-315-4530
Mailing Address - Fax:
Practice Address - Street 1:525 TOWNE SQUARE WAY APT 1516
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6791
Practice Address - Country:US
Practice Address - Phone:321-315-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2021-01-19
Deactivation Date:2020-07-20
Deactivation Code:
Reactivation Date:2021-01-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide