Provider Demographics
NPI:1699088005
Name:SEYMOUR, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SEYMOUR
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 1:48 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:TABERG
Mailing Address - State:NY
Mailing Address - Zip Code:13471-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 JOHN ST
Practice Address - Street 2:
Practice Address - City:TABERG
Practice Address - State:NY
Practice Address - Zip Code:13471-2807
Practice Address - Country:US
Practice Address - Phone:315-371-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267875164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse