Provider Demographics
NPI:1487313698
Name:SEBASTIAN, SHERISSA-NICOLE MARTINEZ (DNP, PMHNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:SHERISSA-NICOLE
Middle Name:MARTINEZ
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, APRN
Other - Prefix:
Other - First Name:SHERISSA-NICOLE
Other - Middle Name:SEBASTIAN
Other - Last Name:MANGANELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1670 E CHEYENNE MOUNTAIN BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4002
Mailing Address - Country:US
Mailing Address - Phone:720-808-1082
Mailing Address - Fax:719-247-1788
Practice Address - Street 1:12041 TEJON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2314
Practice Address - Country:US
Practice Address - Phone:303-993-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95106933163W00000X
CO1644417163WP0808X
CO0998119363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health