Provider Demographics
NPI:1598461519
Name:SANSEEHA, VATCHALIDA
Entity Type:Individual
Prefix:
First Name:VATCHALIDA
Middle Name:
Last Name:SANSEEHA
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 1:1908 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1924
Mailing Address - Country:US
Mailing Address - Phone:828-829-5166
Mailing Address - Fax:
Practice Address - Street 1:6235 ROOSEVELT RD APT 2R
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1176
Practice Address - Country:US
Practice Address - Phone:828-829-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227022165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist