Provider Demographics
NPI:1730718578
Name:SANOGO-GOINES, DJALIKA (APN-FC)
Entity type:Individual
Prefix:MRS
First Name:DJALIKA
Middle Name:
Last Name:SANOGO-GOINES
Suffix:
Gender:F
Credentials:APN-FC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 TOLEDO LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3744
Mailing Address - Country:US
Mailing Address - Phone:215-586-0950
Mailing Address - Fax:
Practice Address - Street 1:87 TOLEDO LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3744
Practice Address - Country:US
Practice Address - Phone:215-586-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01024600207Q00000X, 363LP2300X
PASP022025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine