Healthcare Provider Details

I. General information

NPI: 1992687099
Provider Name (Legal Business Name): SANDY ELSABBAGH M.B.B.CH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST UNIT 600
LOUISVILLE KY
40202-5705
US

IV. Provider business mailing address

401 E CHESTNUT ST UNIT 600
LOUISVILLE KY
40202-5705
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4883
  • Fax: 502-588-4427
Mailing address:
  • Phone: 502-588-4883
  • Fax: 502-588-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: