Provider Demographics
NPI:1861296196
Name:SAMBANA, JUDITH (NP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:SAMBANA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18130 JONES RUN TRL
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2362
Mailing Address - Country:US
Mailing Address - Phone:804-414-5476
Mailing Address - Fax:
Practice Address - Street 1:18130 JONES RUN TRL
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-2362
Practice Address - Country:US
Practice Address - Phone:804-414-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192334363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health