Provider Demographics
NPI:1265090757
Name:BAYER, LILLIAN SEDACCA (PA-C)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:SEDACCA
Last Name:BAYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:MARIE
Other - Last Name:SEDACCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4894 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 HAUCK RD
Practice Address - Street 2:
Practice Address - City:SHARONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45241-4607
Practice Address - Country:US
Practice Address - Phone:513-853-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005895RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant