Provider Demographics
NPI:1447138292
Name:O'DONNELL, SEAN HENRY
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:HENRY
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 ALPINE PL STE 12
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4086
Mailing Address - Country:US
Mailing Address - Phone:702-461-9649
Mailing Address - Fax:702-257-8299
Practice Address - Street 1:4800 ALPINE PL STE 12
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4086
Practice Address - Country:US
Practice Address - Phone:702-461-9649
Practice Address - Fax:702-257-8299
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPRSS-5227175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist