Provider Demographics
NPI:1316430275
Name:SEERAM, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SEERAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7307
Mailing Address - Country:US
Mailing Address - Phone:904-300-3127
Mailing Address - Fax:
Practice Address - Street 1:4313 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7307
Practice Address - Country:US
Practice Address - Phone:314-456-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home