Provider Demographics
NPI:1992241178
Name:KOUDOUOVOH, SANDRINE
Entity type:Individual
Prefix:
First Name:SANDRINE
Middle Name:
Last Name:KOUDOUOVOH
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 1:5409 RIVERDALE RD
Mailing Address - Street 2:APT. J1
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2314
Mailing Address - Country:US
Mailing Address - Phone:240-551-4593
Mailing Address - Fax:
Practice Address - Street 1:5409 RIVERDALE RD
Practice Address - Street 2:APT. J1
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2314
Practice Address - Country:US
Practice Address - Phone:240-551-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12459374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide