Healthcare Provider Details

I. General information

NPI: 1710293139
Provider Name (Legal Business Name): ABDUL R SESAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GOLDEN ROD LN
ROCHESTER NY
14623-3650
US

IV. Provider business mailing address

115 GOLDEN ROD LN
ROCHESTER NY
14623-3650
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-2956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number300309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: