Provider Demographics
NPI:1710250998
Name:SEELYE, DARREN MATTHEW
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:MATTHEW
Last Name:SEELYE
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 1:1750 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3408
Mailing Address - Country:US
Mailing Address - Phone:510-444-1024
Mailing Address - Fax:510-444-1025
Practice Address - Street 1:1750 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3408
Practice Address - Country:US
Practice Address - Phone:510-444-1024
Practice Address - Fax:510-444-1025
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7712237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist