Healthcare Provider Details

I. General information

NPI: 1285375378
Provider Name (Legal Business Name): FATOUMATA SEYDI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5615
US

IV. Provider business mailing address

6070 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5615
US

V. Phone/Fax

Practice location:
  • Phone: 702-803-5534
  • Fax:
Mailing address:
  • Phone: 702-803-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2134
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: