1225230113 NPI number — DR. SEBASTIANO DI PIETRO PHARMD.

Table of content: JACLYN SHLAPACK LPCC (NPI 1336712967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225230113 NPI number — DR. SEBASTIANO DI PIETRO PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DI PIETRO
Provider First Name:
SEBASTIANO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225230113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 WINDERMERE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
N8Y 3E5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
519-987-0631
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18101 OAKWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-4089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-593-7255
Provider Business Practice Location Address Fax Number:
313-593-8823
Provider Enumeration Date:
06/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302034281 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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