Provider Demographics
NPI:1447681069
Name:SEYMOUR, SASHA RENE (CNA)
Entity type:Individual
Prefix:MS
First Name:SASHA
Middle Name:RENE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4410
Mailing Address - Country:US
Mailing Address - Phone:302-543-1180
Mailing Address - Fax:
Practice Address - Street 1:2 S INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4410
Practice Address - Country:US
Practice Address - Phone:302-543-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE000043701008376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide