Individual provider Active NPI

Sofiya Nukalo

  • Certified Registered Nurse Anesthetist
  • Columbia, MD
National Provider Identifier
1407241763
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R262910 Issued in MD
Practice address
5506 Tang PL
Columbia, MD 21045-2629
Phone
(215) 806-8374
NPI assigned
Apr 3, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R262910 MD Primary

Addresses

Primary practice location

5506 Tang PL
Columbia, MD 21045-2629

Mailing address

5506 Tang PL
Columbia, MD 21045-2629

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240430000091 MD Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173963725 Reassigns benefits to 2 organizations
Practice locations: Colmar Manor, MD

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R262910MDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Old Westminster Pike Anesthesia LLC CurrentSince Jun 14, 2024 Accepting new patients
Maryland Endoscopy Anesthesia LLC CurrentSince Jun 14, 2024 Accepting new patients
Quality Medical Management Corp Nurse Anesthetist, Certified Registered CurrentSince May 1, 2024 Accepting new patients

Locations

4155 Bladensburg Rd
Colmar Manor, MD 20722
Phone (301) 277-1545

100 West Rd
Ste 115
Towson, MD 21204
Phone (410) 494-0144

535 Old Westminster Pike
Ste 104
Westminster, MD 21157
Phone (410) 453-8275

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1407241763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5506 TANG PL",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5506 TANG PL",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452629",
            "telephone_number": "215-806-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUKALO",
        "first_name": "SOFIYA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-03",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "R262910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.