Healthcare Provider Details

I. General information

NPI: 1881944676
Provider Name (Legal Business Name): NEDZADA SEHO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 GENESEE ST
UTICA NY
13501-5930
US

IV. Provider business mailing address

874 HIGBY RD
NEW HARTFORD NY
13413-5802
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-8111
  • Fax:
Mailing address:
  • Phone: 315-527-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016012
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016012
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: