Healthcare Provider Details

I. General information

NPI: 1578025045
Provider Name (Legal Business Name): KELSEA JOAN SANDEFUR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MORTLAND RD
SEARSPORT ME
04974-3336
US

IV. Provider business mailing address

37 MORTLAND RD
SEARSPORT ME
04974-3336
US

V. Phone/Fax

Practice location:
  • Phone: 207-548-2475
  • Fax: 207-548-2470
Mailing address:
  • Phone: 207-548-2475
  • Fax: 207-548-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberDO4043
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO4043
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: