Provider Demographics
NPI:1902331713
Name:SEALEY, MAXINE (FNP)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:SEALEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4821
Mailing Address - Country:US
Mailing Address - Phone:718-629-9356
Mailing Address - Fax:718-629-9356
Practice Address - Street 1:5711 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4821
Practice Address - Country:US
Practice Address - Phone:718-629-9356
Practice Address - Fax:718-629-9356
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341042-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily