Healthcare Provider Details

I. General information

NPI: 1336905124
Provider Name (Legal Business Name): DIVYA B SESHADRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
NASHUA NH
03064-2716
US

IV. Provider business mailing address

31 WASHINGTON ST UNIT 312
KEENE NH
03431-3166
US

V. Phone/Fax

Practice location:
  • Phone: 603-689-7936
  • Fax:
Mailing address:
  • Phone: 972-654-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: