Provider Demographics
NPI:1144055351
Name:GOREY, SEAN (CNS, CDN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:GOREY
Suffix:
Gender:M
Credentials:CNS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 AMHERST PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8303
Mailing Address - Country:US
Mailing Address - Phone:203-461-1764
Mailing Address - Fax:
Practice Address - Street 1:110 ALBANY TPKE STE 927
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2552
Practice Address - Country:US
Practice Address - Phone:860-507-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133VN1201X
CT002665133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management