Provider Demographics
NPI:1821446980
Name:WASHINGTON, VICTORIA SADE'
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SADE'
Last Name:WASHINGTON
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 1:196 CAMERON WAY CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5924
Mailing Address - Country:US
Mailing Address - Phone:336-617-7658
Mailing Address - Fax:
Practice Address - Street 1:196 CAMERON WAY CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5924
Practice Address - Country:US
Practice Address - Phone:336-617-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program