Provider Demographics
NPI:1861505638
Name:FENTON, SEAN (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:FENTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9203 OUTLOOK ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-9528
Mailing Address - Country:US
Mailing Address - Phone:917-517-7585
Mailing Address - Fax:419-793-8121
Practice Address - Street 1:251 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5906
Practice Address - Country:US
Practice Address - Phone:917-517-7585
Practice Address - Fax:419-793-8121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY208830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine