Healthcare Provider Details

I. General information

NPI: 1386673473
Provider Name (Legal Business Name): STEPHANIE ANN SEDIVY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W 110TH ST
OVERLAND PARK KS
66210-2304
US

IV. Provider business mailing address

2818 W 66TH TER
MISSION HILLS KS
66208-1811
US

V. Phone/Fax

Practice location:
  • Phone: 913-339-0416
  • Fax: 913-319-4316
Mailing address:
  • Phone: 913-362-2227
  • Fax: 913-362-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number01095343A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number0424745
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberC4202
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number102716
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: