Provider Demographics
NPI:1457835548
Name:SEALES, BRETT D
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:D
Last Name:SEALES
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 1:610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-2416
Mailing Address - Country:US
Mailing Address - Phone:518-368-8866
Mailing Address - Fax:
Practice Address - Street 1:610 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-2416
Practice Address - Country:US
Practice Address - Phone:518-368-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi