Healthcare Provider Details

I. General information

NPI: 1083022966
Provider Name (Legal Business Name): SEVA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9133 SUNSET RIDGE RD
RANDALLSTOWN MD
21133-3651
US

IV. Provider business mailing address

9133 SUNSET RIDGE RD
RANDALLSTOWN MD
21133-3651
US

V. Phone/Fax

Practice location:
  • Phone: 410-299-3803
  • Fax:
Mailing address:
  • Phone: 410-299-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR121021
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR121021
License Number StateMD

VIII. Authorized Official

Name: MRS. ANGEL V SHANNON
Title or Position: EXECUTIVE DIRECTOR
Credential: CRNP
Phone: 410-299-3803