Healthcare Provider Details

I. General information

NPI: 1104912914
Provider Name (Legal Business Name): DEBORAH L COLE-SEDIVY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 W. HENDERSON ROAD SUITE 100
COLUMBUS OH
43220
US

IV. Provider business mailing address

3260 W. HENDERSON ROAD SUITE 100
COLUMBUS OH
43220
US

V. Phone/Fax

Practice location:
  • Phone: 614-545-2002
  • Fax: 614-545-7546
Mailing address:
  • Phone: 614-545-2002
  • Fax: 614-545-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-004212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: