Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101236265 | VA |
NPI | 1124004452 |
---|---|
Provider Name | Dr. Deryk Christopher Sequeira |
First Address | Richmond, VA 23291-1734 |
Second Address | North Chesterfield, VA 23235-4730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 18/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010082668 | (05) | VA |