Provider Demographics
NPI:1578025045
Name:SANDEFUR, KELSEA JOAN (DO)
Entity type:Individual
Prefix:DR
First Name:KELSEA
Middle Name:JOAN
Last Name:SANDEFUR
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-3336
Mailing Address - Country:US
Mailing Address - Phone:207-548-2475
Mailing Address - Fax:207-548-2470
Practice Address - Street 1:37 MORTLAND RD
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3336
Practice Address - Country:US
Practice Address - Phone:207-548-2475
Practice Address - Fax:207-548-2470
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO40432083S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine