Provider Demographics
NPI:1750816187
Name:SEWELL, EBONY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 WHITE SWAN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5323
Mailing Address - Country:US
Mailing Address - Phone:585-709-7052
Mailing Address - Fax:
Practice Address - Street 1:3755 WHITE SWAN DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5323
Practice Address - Country:US
Practice Address - Phone:585-709-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341777600302E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide