Healthcare Provider Details

I. General information

NPI: 1366374704
Provider Name (Legal Business Name): SEYLA CORINNE O'HEARN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ALDRIN RD
PLYMOUTH MA
02360-4804
US

IV. Provider business mailing address

31 FLINTLOCK WAY
YARMOUTH PORT MA
02675-1108
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-8977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1222485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: