Provider Demographics
NPI:1568161941
Name:DESALEGNE, SENTAYHU WENDEMU
Entity Type:Individual
Prefix:
First Name:SENTAYHU
Middle Name:WENDEMU
Last Name:DESALEGNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 CLEMSON DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5243
Mailing Address - Country:US
Mailing Address - Phone:469-982-0140
Mailing Address - Fax:
Practice Address - Street 1:4306 CLEMSON DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5243
Practice Address - Country:US
Practice Address - Phone:469-982-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37183171172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver