Healthcare Provider Details

I. General information

NPI: 1891456463
Provider Name (Legal Business Name): SANELA SEHOVIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANELA RUCIC

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 CHAMPLIN AVE
NEW HARTFORD NY
13413-1068
US

IV. Provider business mailing address

2209 GENESEE ST
UTICA NY
13501-5999
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-8080
  • Fax: 315-624-4748
Mailing address:
  • Phone: 315-801-4238
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10211002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: