Provider Demographics
NPI:1053033324
Name:SESI, RIVONDA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RIVONDA
Middle Name:
Last Name:SESI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RIVONDA
Other - Middle Name:
Other - Last Name:HIRMIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4850 VINEYARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1961
Mailing Address - Country:US
Mailing Address - Phone:586-480-8929
Mailing Address - Fax:
Practice Address - Street 1:441 S LIVERNOIS RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2585
Practice Address - Country:US
Practice Address - Phone:248-608-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011256APP22363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601011256APP22OtherLICENSE NUMBER