Provider Demographics
NPI:1982717732
Name:SEQUEIRA, RODRIGO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:JOSE
Last Name:SEQUEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RODRIGO
Other - Middle Name:JOSE
Other - Last Name:SEQUEIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACS PC
Mailing Address - Street 1:5717 138TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5040
Mailing Address - Country:US
Mailing Address - Phone:718-458-2681
Mailing Address - Fax:718-762-5262
Practice Address - Street 1:5717 138TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5040
Practice Address - Country:US
Practice Address - Phone:718-458-2681
Practice Address - Fax:718-762-5262
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158886208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery