Healthcare Provider Details

I. General information

NPI: 1679784433
Provider Name (Legal Business Name): SELLERSBURG PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 WILLIAMSBURG DRIVE SUITE 3
JEFFERSONVILLE IN
47130-8065
US

IV. Provider business mailing address

1730 WILLIAMSBURG DRIVE SUITE 3
JEFFERSONVILLE IN
47130-8065
US

V. Phone/Fax

Practice location:
  • Phone: 812-246-0705
  • Fax: 812-246-0710
Mailing address:
  • Phone: 812-246-0705
  • Fax: 812-246-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01043740A
License Number StateIN

VIII. Authorized Official

Name: DR. SANDRA KAY HENSLEY
Title or Position: OWNER
Credential: MD
Phone: 812-246-0705