Provider Demographics
NPI:1790403194
Name:SECKLEY-BROWN, HILDA SELASI
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:SELASI
Last Name:SECKLEY-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PELHAM PKWY S APT 6K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1132
Mailing Address - Country:US
Mailing Address - Phone:347-341-9732
Mailing Address - Fax:
Practice Address - Street 1:1540 PELHAM PKWY S APT 6K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1132
Practice Address - Country:US
Practice Address - Phone:347-341-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily