Healthcare Provider Details

I. General information

NPI: 1205969607
Provider Name (Legal Business Name): SANDI MAE VIVIENNE SEE TAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ERIE AVE AT FRONT ST
PHILADELPHIA PA
19134
US

IV. Provider business mailing address

780 S PARK DR
HADDON TOWNSHIP NJ
08108-2236
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5190
  • Fax:
Mailing address:
  • Phone: 856-854-6655
  • Fax: 484-865-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD063599L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: