Healthcare Provider Details

I. General information

NPI: 1336554336
Provider Name (Legal Business Name): SEPA DEVON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 LANCASTER AVE
DEVON PA
19333-1316
US

IV. Provider business mailing address

860 LANCASTER AVE
DEVON PA
19333-1316
US

V. Phone/Fax

Practice location:
  • Phone: 855-235-7246
  • Fax:
Mailing address:
  • Phone: 855-235-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PHILIP J. SASSO
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 215-277-5888