Healthcare Provider Details

I. General information

NPI: 1013166198
Provider Name (Legal Business Name): TANDALAYA SARAH CANNON-PHILLIPS SEERS LAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 06/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 RHAWN ST APT 12A
PHILADELPHIA PA
19111-2513
US

IV. Provider business mailing address

714 RHAWN ST APT 12A
PHILADELPHIA PA
19111-2513
US

V. Phone/Fax

Practice location:
  • Phone: 215-725-0648
  • Fax: 267-467-0046
Mailing address:
  • Phone: 215-725-0648
  • Fax: 267-467-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberCNA 9994672
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: