Provider Demographics
NPI:1508495045
Name:SASTRIQUES DUNLOP, SERGIO EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:EDUARDO
Last Name:SASTRIQUES DUNLOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 IVANHOE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2245
Mailing Address - Country:US
Mailing Address - Phone:314-393-3135
Mailing Address - Fax:
Practice Address - Street 1:600 GRESHAM DR STE 8620
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-6402
Practice Address - Fax:757-961-6440
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program