Provider Demographics
NPI:1134498959
Name:SEEPERSAUD, TERRANCE
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:SEEPERSAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17414 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2526
Mailing Address - Country:US
Mailing Address - Phone:917-957-3106
Mailing Address - Fax:
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:ROOM 403
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2559
Practice Address - Country:US
Practice Address - Phone:718-630-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY530758-1163WC0200X
NY530758367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine