Provider Demographics
NPI:1942000518
Name:JOLLY, SEBIN (RN)
Entity type:Individual
Prefix:
First Name:SEBIN
Middle Name:
Last Name:JOLLY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 EUCLID AVE APT 1207S
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1504
Mailing Address - Country:US
Mailing Address - Phone:505-340-4381
Mailing Address - Fax:
Practice Address - Street 1:1010 EUCLID AVE APT 1207S
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1504
Practice Address - Country:US
Practice Address - Phone:505-340-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH539065163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine