Healthcare Provider Details

I. General information

NPI: 1033314919
Provider Name (Legal Business Name): REBECCA AMERLIA KURNIK SESHASAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST 1 FOUNDERS
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2638
  • Fax:
Mailing address:
  • Phone: 215-662-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD448464
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: