Provider Demographics
NPI:1134351125
Name:SEBASTIAN, SHAMEEKA
Entity type:Individual
Prefix:
First Name:SHAMEEKA
Middle Name:
Last Name:SEBASTIAN
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 1:68 BIRCH PL
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-3812
Mailing Address - Country:US
Mailing Address - Phone:203-805-3942
Mailing Address - Fax:
Practice Address - Street 1:68 BIRCH PL
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3812
Practice Address - Country:US
Practice Address - Phone:203-805-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse