Healthcare Provider Details

I. General information

NPI: 1447705215
Provider Name (Legal Business Name): SANDEEP SEBASTIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 W SPRING CREEK PKWY SUITE 400
PLANO TX
75023-3953
US

IV. Provider business mailing address

3013 W SPRING CREEK PKWY SUITE 400
PLANO TX
75023-3953
US

V. Phone/Fax

Practice location:
  • Phone: 214-427-7211
  • Fax:
Mailing address:
  • Phone: 214-427-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: