Provider Demographics
NPI:1861089732
Name:LONTOUO, SANDIE HELYETTE LONFO (FNP)
Entity type:Individual
Prefix:
First Name:SANDIE HELYETTE
Middle Name:LONFO
Last Name:LONTOUO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6426 EDSALL RD APT 202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-6465
Mailing Address - Country:US
Mailing Address - Phone:571-232-8958
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTRAL AVE STE 302A
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4853
Practice Address - Country:US
Practice Address - Phone:301-613-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180027363LF0000X
MDAC003638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424985200Medicaid