Healthcare Provider Details

I. General information

NPI: 1205075041
Provider Name (Legal Business Name): SUNIT SEBASTIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 TAUB LOOP
HOUSTON TX
77030-1608
US

IV. Provider business mailing address

2500 NORTH STATE STREET
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-2412
  • Fax:
Mailing address:
  • Phone: 601-984-2538
  • Fax: 601-815-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberN/A
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number766-L
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47974
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: