Provider Demographics
NPI:1215701321
Name:KANU, SAUDY ELIZABETH
Entity type:Individual
Prefix:
First Name:SAUDY
Middle Name:ELIZABETH
Last Name:KANU
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 1:8115 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759
Mailing Address - Country:US
Mailing Address - Phone:240-786-4527
Mailing Address - Fax:
Practice Address - Street 1:8115 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759
Practice Address - Country:US
Practice Address - Phone:240-786-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231533363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty