Provider Demographics
NPI:1255608402
Name:REEG, SEANNA A (PA-C)
Entity type:Individual
Prefix:
First Name:SEANNA
Middle Name:A
Last Name:REEG
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:SEANNA
Other - Middle Name:AMANDA
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4885 OLENTANGY RIVER RD STE 1-20
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1953
Mailing Address - Country:US
Mailing Address - Phone:614-268-6555
Mailing Address - Fax:614-457-5713
Practice Address - Street 1:4885 OLENTANGY RIVER RD STE 1-20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1953
Practice Address - Country:US
Practice Address - Phone:614-268-6555
Practice Address - Fax:614-457-5713
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003779RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085113Medicaid
OH0085113Medicaid