Provider Demographics
NPI:1376825992
Name:SEDITA, STEPHEN (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SEDITA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N GOODMAN ST STE 227
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1554
Mailing Address - Country:US
Mailing Address - Phone:423-430-9543
Mailing Address - Fax:
Practice Address - Street 1:16 N GOODMAN ST STE 227
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1554
Practice Address - Country:US
Practice Address - Phone:585-542-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007022171100000X
TN235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist