Provider Demographics
NPI:1851373559
Name:SEQUEIRA, DEBRA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23974-0070
Mailing Address - Country:US
Mailing Address - Phone:434-696-2165
Mailing Address - Fax:434-696-1557
Practice Address - Street 1:8920 OTTERBURN ROAD
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:VA
Practice Address - Zip Code:23002
Practice Address - Country:US
Practice Address - Phone:804-561-5150
Practice Address - Fax:804-561-6643
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010192854Medicaid
VA008775S00Medicare ID - Type Unspecified
VA010192854Medicaid