Provider Demographics
NPI:1932464161
Name:SANGAH, DELLA AMA (CRNP)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:AMA
Last Name:SANGAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15429 SYMONDSBURY WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8053
Mailing Address - Country:US
Mailing Address - Phone:410-707-9731
Mailing Address - Fax:
Practice Address - Street 1:15429 SYMONDSBURY WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8053
Practice Address - Country:US
Practice Address - Phone:410-707-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily