Provider Demographics
NPI:1760021711
Name:SOSEDOV, SERGHEI
Entity type:Individual
Prefix:
First Name:SERGHEI
Middle Name:
Last Name:SOSEDOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LARKSPUR RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2719
Mailing Address - Country:US
Mailing Address - Phone:267-679-4271
Mailing Address - Fax:
Practice Address - Street 1:6 LARKSPUR RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-2719
Practice Address - Country:US
Practice Address - Phone:267-679-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA46073601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide