Provider Demographics
NPI:1700219565
Name:SEBO, ANDREA PHYLLIS (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:PHYLLIS
Last Name:SEBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BAY AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-1507
Mailing Address - Country:US
Mailing Address - Phone:516-584-6050
Mailing Address - Fax:
Practice Address - Street 1:14 BAY AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-1507
Practice Address - Country:US
Practice Address - Phone:516-584-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse