Healthcare Provider Details

I. General information

NPI: 1023437092
Provider Name (Legal Business Name): SEULKIH D'ANDREA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SEULKIH SHIN

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ELM ST
HARRINGTON PARK NJ
07640-1902
US

IV. Provider business mailing address

644 6TH AVE # 2
BROOKLYN NY
11215-5403
US

V. Phone/Fax

Practice location:
  • Phone: 201-784-0123
  • Fax:
Mailing address:
  • Phone: 516-721-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA099584800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: