Provider Demographics
NPI:1134743719
Name:SEAT, ROMA VASUDEV (RN, RD, CLC, IBCLC)
Entity type:Individual
Prefix:
First Name:ROMA
Middle Name:VASUDEV
Last Name:SEAT
Suffix:
Gender:F
Credentials:RN, RD, CLC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 GLENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5499
Mailing Address - Country:US
Mailing Address - Phone:773-505-7662
Mailing Address - Fax:
Practice Address - Street 1:24014 W RENWICK RD UNIT 105
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8729
Practice Address - Country:US
Practice Address - Phone:773-505-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL987462133V00000X
IL041518743163W00000X
OHRN.369070163W00000X, 163WL0100X
OHL-151275163WL0100X
ILL-151275163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse