Provider Demographics
NPI:1235891722
Name:ANDERSON, SEQUITA SHONTAE
Entity Type:Individual
Prefix:
First Name:SEQUITA
Middle Name:SHONTAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SEQUITA
Other - Middle Name:SHONTAE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:184 CARBON ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1231
Mailing Address - Country:US
Mailing Address - Phone:862-297-1485
Mailing Address - Fax:
Practice Address - Street 1:184 CARBON ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1231
Practice Address - Country:US
Practice Address - Phone:862-297-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010796-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty