Provider Demographics
NPI:1538782826
Name:KURZDORFER, SEAN (PMHNP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KURZDORFER
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:KURZDORFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 ALLENS CREEK RD STE 330
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3246
Mailing Address - Country:US
Mailing Address - Phone:585-360-7554
Mailing Address - Fax:949-577-4708
Practice Address - Street 1:95 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3250
Practice Address - Country:US
Practice Address - Phone:585-360-7554
Practice Address - Fax:949-577-4708
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70145363LP0808X
OR10012124363LP0808X
MDR268663363LP0808X
NY402976363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty