Provider Demographics
NPI:1467295071
Name:ASBURY, SEQUARIA MONIQUE (CPSW,CYPSS,CHW,CCSS)
Entity type:Individual
Prefix:
First Name:SEQUARIA
Middle Name:MONIQUE
Last Name:ASBURY
Suffix:
Gender:F
Credentials:CPSW,CYPSS,CHW,CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 65TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2357
Mailing Address - Country:US
Mailing Address - Phone:505-808-9414
Mailing Address - Fax:
Practice Address - Street 1:228 65TH ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2357
Practice Address - Country:US
Practice Address - Phone:505-808-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1445175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist