Provider Demographics
NPI:1760717599
Name:SEIDELL, VANESSA LEIGH (RPA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEIGH
Last Name:SEIDELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 UNION ST
Mailing Address - Street 2:APARTMENT #3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1161
Mailing Address - Country:US
Mailing Address - Phone:315-706-3039
Mailing Address - Fax:
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:10TH FLOOR SUITE 1000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-254-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135921363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical