Provider Demographics
NPI:1467888008
Name:SEBASTIAN, THURAVATHUCKAL (MD)
Entity Type:Individual
Prefix:DR
First Name:THURAVATHUCKAL
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T
Other - Middle Name:C
Other - Last Name:SEBASTIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:219 WHISPERING OAKS CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1727
Mailing Address - Country:US
Mailing Address - Phone:941-341-0273
Mailing Address - Fax:941-341-0273
Practice Address - Street 1:219 WHISPERING OAKS CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1727
Practice Address - Country:US
Practice Address - Phone:941-341-0273
Practice Address - Fax:941-341-0273
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL555398Medicaid
FL37206Medicare UPIN