Healthcare Provider Details

I. General information

NPI: 1083054803
Provider Name (Legal Business Name): SEAMUS MCCOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BROADWAY SUITE 500
OAKLAND CA
94612-2141
US

IV. Provider business mailing address

1700 BROADWAY SUITE 500
OAKLAND CA
94612-2141
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95000954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number806399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: