Provider Demographics
NPI:1205227543
Name:SEALEE, JILL (LAC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:SEALEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-6100
Mailing Address - Country:US
Mailing Address - Phone:917-993-0597
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E STE 411
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3222
Practice Address - Country:US
Practice Address - Phone:917-993-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25-005410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist