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General NPI Number Information
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NPI Number | 1396113627
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Entity Type | Individual
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Provider Name | PRAFULLA RAJANI SEQUEIRA
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Gender | Female
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 1503 LANSDOWNE AVE STE 3001
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City | DARBY
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State | PA
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Zip | 19023-1306
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Country | US
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Telephone | 610-586-4100
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Fax | 610-586-4114
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Provider Business Mailing Address
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Address Line | 264 W ESSEX AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1509
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Country | US
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Telephone |
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | SP015777
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | SP020230
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP015777
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License Number State | PA
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