Provider Demographics
NPI:1265293583
Name:SEBANENYA, ISAAC
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:SEBANENYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 RANGEWAY RD UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-2034
Mailing Address - Country:US
Mailing Address - Phone:781-325-2238
Mailing Address - Fax:
Practice Address - Street 1:147 RANGEWAY RD UNIT 1203
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2034
Practice Address - Country:US
Practice Address - Phone:781-325-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2373876163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health