Individual
SOUDABEH K. BANANKHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-0465
Mailing address
PO BOX 64382, BALTIMORE, MD 21264-4382
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R106053
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017158100
—
MD
Enumeration date
04/23/2008
Last updated
06/25/2008
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