Provider Demographics
NPI:1457401168
Name:SEPULVEDA, CELESTINO EDDIE II (MD)
Entity Type:Individual
Prefix:DR
First Name:CELESTINO
Middle Name:EDDIE
Last Name:SEPULVEDA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:207 WASHINGTON STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-471-0800
Mailing Address - Fax:845-471-0811
Practice Address - Street 1:207 WASHINGTON STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-471-0800
Practice Address - Fax:845-471-0811
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY172205-2208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01051876Medicaid
NYBS1032123OtherDEA
NYBS1032123OtherDEA
NY13E681Medicare ID - Type Unspecified