Healthcare Provider Details

I. General information

NPI: 1508742578
Provider Name (Legal Business Name): SAMEERA SYEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N73W28651 BARK RIVER RD
HARTLAND WI
53029-8323
US

IV. Provider business mailing address

N73W28651 BARK RIVER RD
HARTLAND WI
53029-8323
US

V. Phone/Fax

Practice location:
  • Phone: 262-337-5316
  • Fax:
Mailing address:
  • Phone: 262-337-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002223
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: