Provider Demographics
NPI:1700205952
Name:KELLY, SEAN (DO)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 THREE CHOPT RD RM 119
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4837
Mailing Address - Country:US
Mailing Address - Phone:804-527-2800
Mailing Address - Fax:804-420-1075
Practice Address - Street 1:1501 MAPLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2553
Practice Address - Country:US
Practice Address - Phone:804-285-2300
Practice Address - Fax:804-418-3062
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207131207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program