1003513680 NPI number — NARIAH DALEEAH SEDESSE BEHAVIOR TECHNICIAN

Table of content: NARIAH DALEEAH SEDESSE BEHAVIOR TECHNICIAN (NPI 1003513680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003513680 NPI number — NARIAH DALEEAH SEDESSE BEHAVIOR TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEDESSE
Provider First Name:
NARIAH
Provider Middle Name:
DALEEAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BEHAVIOR TECHNICIAN
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:
1003513680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360595
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-6595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-215-5311
Provider Business Mailing Address Fax Number:
718-865-5165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 LANDMARK DR STE 117-121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-4980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-865-5165
Provider Business Practice Location Address Fax Number:
718-865-5165
Provider Enumeration Date:
02/14/2023

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: 106S00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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