Provider Demographics
NPI:1669119640
Name:ATU, SOPHIA UGONMA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:UGONMA
Last Name:ATU
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 1:9203 ROLLING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2457
Mailing Address - Country:US
Mailing Address - Phone:240-535-0454
Mailing Address - Fax:240-683-6203
Practice Address - Street 1:610 PROFESSIONAL DR STE 255
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3463
Practice Address - Country:US
Practice Address - Phone:240-683-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191076163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health