Provider Demographics
NPI:1700113289
Name:SESTAK, ANDREA L (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:SESTAK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7651
Mailing Address - Country:US
Mailing Address - Phone:405-255-4170
Mailing Address - Fax:650-727-5319
Practice Address - Street 1:3555 NW 58TH ST STE 804
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4703
Practice Address - Country:US
Practice Address - Phone:405-548-0430
Practice Address - Fax:405-463-4408
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK22950208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics