Provider Demographics
NPI:1447705215
Name:SEBASTIAN, SANDEEP (DPM)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3953
Mailing Address - Country:US
Mailing Address - Phone:214-427-7211
Mailing Address - Fax:
Practice Address - Street 1:3013 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-3953
Practice Address - Country:US
Practice Address - Phone:214-427-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2233213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery