Provider Demographics
NPI:1548383482
Name:NANCY A SEDAT MS-CCC-SLP
Entity Type:Organization
Organization Name:NANCY A SEDAT MS-CCC-SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEDAT
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:310-264-8300
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 785
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-264-8300
Mailing Address - Fax:310-264-8360
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:SUITE 785
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-264-8300
Practice Address - Fax:310-264-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2415261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA556563Medicare ID - Type Unspecified