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General NPI Number Information
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NPI Number | 1578025045
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Entity Type | Individual
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Provider Name | KELSEA JOAN SANDEFUR DO
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Gender | Female
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 37 MORTLAND RD
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City | SEARSPORT
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State | ME
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Zip | 04974-3336
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Country | US
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Telephone | 207-548-2475
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Fax | 207-548-2470
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Provider Business Mailing Address
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Address Line | 37 MORTLAND RD
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City | SEARSPORT
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State | ME
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Zip | 04974-3336
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Country | US
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Telephone | 207-548-2475
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Fax | 207-548-2470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | DO4043
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | DO4043
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License Number State | ME
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