Healthcare Provider Details

I. General information

NPI: 1407778285
Provider Name (Legal Business Name): WARANA SEBIYAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 16TH ST
BROOKLYN NY
11226-4519
US

IV. Provider business mailing address

301 E 16TH ST PH
BROOKLYN NY
11226-4519
US

V. Phone/Fax

Practice location:
  • Phone: 347-499-2985
  • Fax:
Mailing address:
  • Phone: 347-499-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number321075-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: