Healthcare Provider Details

I. General information

NPI: 1134498959
Provider Name (Legal Business Name): TERRANCE SEEPERSAUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH STREET ROOM 403
BROOKLYN NY
11225-2559
US

IV. Provider business mailing address

17414 108TH AVE
JAMAICA NY
11433-2526
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6324
  • Fax:
Mailing address:
  • Phone: 917-957-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number530758-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number530758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: