Provider Demographics
NPI:1982416293
Name:SANFORD, DEJA OMARIYAH
Entity type:Individual
Prefix:
First Name:DEJA
Middle Name:OMARIYAH
Last Name:SANFORD
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 1:228 W CHURCH ST APT B
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2982
Mailing Address - Country:US
Mailing Address - Phone:937-725-1524
Mailing Address - Fax:
Practice Address - Street 1:228 W CHURCH ST APT B
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2982
Practice Address - Country:US
Practice Address - Phone:937-725-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide