Provider Demographics
NPI:1023594439
Name:FOMBAD, SANDRINE ANGWI
Entity type:Individual
Prefix:
First Name:SANDRINE ANGWI
Middle Name:
Last Name:FOMBAD
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 1:7709 RIVERDALE RD APT 202
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3941
Mailing Address - Country:US
Mailing Address - Phone:240-616-8991
Mailing Address - Fax:
Practice Address - Street 1:7709 RIVERDALE RD APT 202
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3941
Practice Address - Country:US
Practice Address - Phone:240-616-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide