Healthcare Provider Details

I. General information

NPI: 1699448563
Provider Name (Legal Business Name): SEBASTIAN JOSE VALLEJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 GALE LEMERAND DR
GAINESVILLE FL
32610-3008
US

IV. Provider business mailing address

PO BOX 100226
GAINESVILLE FL
32610-0226
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8655
  • Fax:
Mailing address:
  • Phone: 352-273-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME177368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: