Healthcare Provider Details

I. General information

NPI: 1639073661
Provider Name (Legal Business Name): EILEEN SEERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 WINDSOR RD
MEDFORD MA
02155-5926
US

IV. Provider business mailing address

117 WINDSOR RD
MEDFORD MA
02155-5926
US

V. Phone/Fax

Practice location:
  • Phone: 518-852-4383
  • Fax:
Mailing address:
  • Phone: 518-852-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2343377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: