Provider Demographics
NPI:1336405711
Name:SEASLY, STEPHANIE NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:SEASLY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9127
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70055-9127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:301-703-2199
Practice Address - Street 1:27 E 28TH ST FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7921
Practice Address - Country:US
Practice Address - Phone:877-456-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101270381207Q00000X, 2083A0300X
LAMD.206792207Q00000X
LAMD206792207QA0401X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2199650Medicaid