Healthcare Provider Details

I. General information

NPI: 1982913844
Provider Name (Legal Business Name): SEBASTIEN MARIE GERARD DE FERAUDY MD-PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 SAMARITAN DR
SAN JOSE CA
95124
US

IV. Provider business mailing address

6 BEACH RD UNIT 229
TIBURON CA
94920-2802
US

V. Phone/Fax

Practice location:
  • Phone: 408-369-5600
  • Fax: 408-369-5625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA118148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: