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General NPI Number Information
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NPI Number | 1154373272
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Entity Type | Individual
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Provider Name | KELLY BIANCA SEAB-TETRICK MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 501 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-2787
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Country | US
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Telephone | 843-549-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 26800 S TAMIAMI TRL STE 100
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4349
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Country | US
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Telephone | 843-549-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 22351
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License Number State | SC
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