MEDICARE: DR. SEAN THOMAS KENNIFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME114457	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	HF125Y	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720308034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN THOMAS KENNIFF M.D.

Provider Business Mailing Address
First Line	:	2900 CORPORATE WAY
Second Line	:	DOOR D
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3925
Country	:	US
Telephone Number	:	954-276-5685
Fax Number	:	954-985-7074

Provider Business Practice Location Address
First Line	:	1150 N 35TH AVE STE 590
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5468
Country	:	US
Telephone Number	:	954-265-9500
Fax Number	:	954-265-1431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	03/15/2021

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Directions to “ DR. SEAN THOMAS KENNIFF M.D.” Practice Location

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