Healthcare Provider Details

I. General information

NPI: 1336405711
Provider Name (Legal Business Name): STEPHANIE NICOLE SEASLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E 28TH ST FL 12
NEW YORK NY
10016-7921
US

IV. Provider business mailing address

PO BOX 9127
METAIRIE LA
70055-9127
US

V. Phone/Fax

Practice location:
  • Phone: 877-456-2683
  • Fax:
Mailing address:
  • Phone:
  • Fax: 301-703-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101270381
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.206792
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71063
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number0101270381
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD206792
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: