Provider Demographics
NPI:1013166198
Name:CANNON-PHILLIPS, TANDALAYA SARAH (SEERS LAMA)
Entity Type:Individual
Prefix:MS
First Name:TANDALAYA
Middle Name:SARAH
Last Name:CANNON-PHILLIPS
Suffix:
Gender:F
Credentials:SEERS LAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 RHAWN ST
Mailing Address - Street 2:APT 12A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2513
Mailing Address - Country:US
Mailing Address - Phone:215-725-0648
Mailing Address - Fax:267-467-0046
Practice Address - Street 1:714 RHAWN ST
Practice Address - Street 2:APT 12A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2513
Practice Address - Country:US
Practice Address - Phone:215-725-0648
Practice Address - Fax:267-467-0046
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246R00000X, 171M00000X, 246W00000X, 246ZS0410X, 2470A2800X, 133N00000X, 374U00000X, 376K00000X
PACNA 99946723747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide