Provider Demographics
NPI:1447022843
Name:ANIUGO, SANDRA NGOZI
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:NGOZI
Last Name:ANIUGO
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 1:23326 BREWERS TAVERN WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4369
Mailing Address - Country:US
Mailing Address - Phone:240-308-4320
Mailing Address - Fax:
Practice Address - Street 1:23326 BREWERS TAVERN WAY
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4369
Practice Address - Country:US
Practice Address - Phone:240-308-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN200004348163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health