Provider Demographics
NPI:1053904094
Name:KROTMAN, SANDRA LEIGH (APRN-PMH, PMH-NP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEIGH
Last Name:KROTMAN
Suffix:
Gender:F
Credentials:APRN-PMH, PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4341
Mailing Address - Country:US
Mailing Address - Phone:202-794-2901
Mailing Address - Fax:
Practice Address - Street 1:1680 E GUDE DR STE 315
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1372
Practice Address - Country:US
Practice Address - Phone:301-250-0404
Practice Address - Fax:302-637-7970
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health