Provider Demographics
NPI:1356352959
Name:SEEL, CODY (PA-C)
Entity type:Individual
Prefix:MS
First Name:CODY
Middle Name:
Last Name:SEEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 NAVARRO PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3022
Mailing Address - Country:US
Mailing Address - Phone:303-506-4649
Mailing Address - Fax:
Practice Address - Street 1:3816 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7048
Practice Address - Country:US
Practice Address - Phone:512-448-8278
Practice Address - Fax:512-448-8293
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05634363AM0700X
CO2102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04076028Medicaid
COQ50353Medicare UPIN
COC806781Medicare PIN