MEDICARE: MS. TANDALAYA SARAH CANNON-PHILLIPS SEERS LAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	171M00000X	Case Manager/Care Coordinator
3	246R00000X	Pathology Technician
4	246W00000X	Cardiology Technician
5	246ZS0410X	Surgical Technologist
6	2470A2800X	Assistant Health Information Record Technician
7	374U00000X	Home Health Aide
8	376K00000X	Nurse's Aide
9	3747P1801X	Personal Care Attendant	CNA 9994672	PA

General Provider Information

NPI Number	:	1013166198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANDALAYA SARAH CANNON-PHILLIPS SEERS LAMA

Provider Business Mailing Address
First Line	:	714 RHAWN ST
Second Line	:	APT 12A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2513
Country	:	US
Telephone Number	:	215-725-0648
Fax Number	:	267-467-0046

Provider Business Practice Location Address
First Line	:	714 RHAWN ST
Second Line	:	APT 12A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2513
Country	:	US
Telephone Number	:	215-725-0648
Fax Number	:	267-467-0046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	06/24/2024

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