Individual
SEBASTINE I ELENDU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 HOUSE AVE, SUITE 201, CHEYENNE, WY 82001-3176
(307) 638-7757
Mailing address
1559 208TH PL, BAYSIDE, NY 11360-1121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
199938
LA
207R00000X
Internal Medicine Physician
32334
SC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
32334
SC
207RP1001X
Pulmonary Disease Physician
32334
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02053740
—
MS
05
—
1076350
—
LA
01
—
GP3912
MEDICAID GROUP
SC
01
—
GP4306
MEDICAID GROUP
SC
05
—
NC1134
—
SC
Enumeration date
07/25/2006
Last updated
05/20/2015
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