Healthcare Provider Details

I. General information

NPI: 1205759768
Provider Name (Legal Business Name): ABDALLAH SEVEDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 PARK AVE
NEW YORK NY
10035-1901
US

IV. Provider business mailing address

1767 PARK AVE
NEW YORK NY
10035-1901
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3032
  • Fax:
Mailing address:
  • Phone: 929-656-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: