1720830524 NPI number — SUSANA SEBESTYEN OD, FAAO, CEDH, IMD

Table of content: SUSANA SEBESTYEN OD, FAAO, CEDH, IMD (NPI 1720830524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720830524 NPI number — SUSANA SEBESTYEN OD, FAAO, CEDH, IMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEBESTYEN
Provider First Name:
SUSANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD, FAAO, CEDH, IMD
Provider Gender Code:
F

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:
1720830524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1148 WINSTON CHURCHILL BLVD UNIT B2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKVILLE
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L6J OA3
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1148 WINSTON CHURCHILL BLVD UNIT B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKVILLE
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
L6J OA3
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
905-338-6633
Provider Business Practice Location Address Fax Number:
905-338-6659
Provider Enumeration Date:
04/04/2024

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: 152W00000X , with the licence number:  9333 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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