Healthcare Provider Details

I. General information

NPI: 1740371129
Provider Name (Legal Business Name): VERONIQUE SEBASTIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W MEMORIAL RD STE 218
OKLAHOMA CITY OK
73120-6103
US

IV. Provider business mailing address

12800 CASTLEROCK CT
OKLAHOMA CITY OK
73142-5127
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-5801
  • Fax: 405-755-5802
Mailing address:
  • Phone: 405-245-5646
  • Fax: 405-755-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20879
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: