Provider Demographics
NPI:1023485661
Name:SEALY, BAMBI
Entity type:Individual
Prefix:MRS
First Name:BAMBI
Middle Name:
Last Name:SEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8160
Mailing Address - Country:US
Mailing Address - Phone:850-396-6249
Mailing Address - Fax:850-396-6249
Practice Address - Street 1:6708 BRYANT ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8160
Practice Address - Country:US
Practice Address - Phone:850-396-6249
Practice Address - Fax:850-396-6249
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency