Provider Demographics
NPI:1922474469
Name:SEBASTIAN, MANOJKUMAR E (NNP)
Entity Type:Individual
Prefix:MR
First Name:MANOJKUMAR
Middle Name:E
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 S ISABELL ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6459
Mailing Address - Country:US
Mailing Address - Phone:720-922-3717
Mailing Address - Fax:
Practice Address - Street 1:1375 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1550
Practice Address - Country:US
Practice Address - Phone:303-812-4442
Practice Address - Fax:303-812-4239
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991911-NP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal