Healthcare Provider Details

I. General information

NPI: 1720395387
Provider Name (Legal Business Name): SANGEETHA SESHADRI MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 RESEARCH WAY
EAST SETAUKET NY
11733-3526
US

IV. Provider business mailing address

PO BOX 1554
STONY BROOK NY
11790-0988
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-0580
  • Fax: 631-444-0562
Mailing address:
  • Phone: 631-444-0650
  • Fax: 631-638-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number257337
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number257337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: