Provider Demographics
NPI:1225711047
Name:OKENGWU, SANDRA BLESSING
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:BLESSING
Last Name:OKENGWU
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 1:626 N FRENCH RD STE 5
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2105
Mailing Address - Country:US
Mailing Address - Phone:716-232-0887
Mailing Address - Fax:716-287-8297
Practice Address - Street 1:626 N FRENCH RD STE 5
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2105
Practice Address - Country:US
Practice Address - Phone:716-232-0887
Practice Address - Fax:716-287-8297
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404837363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health