Provider Demographics
NPI:1205969607
Name:SEE TAI, SANDI MAE VIVIENNE (MD)
Entity type:Individual
Prefix:
First Name:SANDI MAE
Middle Name:VIVIENNE
Last Name:SEE TAI
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 1:780 S PARK DR
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2236
Mailing Address - Country:US
Mailing Address - Phone:856-854-6655
Mailing Address - Fax:484-865-4355
Practice Address - Street 1:ERIE AVE AT FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-427-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063599L2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018649460001Medicaid
H53826Medicare UPIN
053828Medicare ID - Type Unspecified